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Orthopedic Coding Alert

ICD-10 Coding:
Look to these Rib Fracture Dx Codes for Open/Closed Fixes

Remember the S22.--- codes for breaks.

Orthopedic practices that treat patients for rib fractures will want to take heed to these diagnosis coding tips.

Why? Your diagnosis coding needs to be spot-on to ensure optimal care for your patients suffering from rib fractures. Specifically, diagnosis codes for single-rib fractures just won't cut it on claims for patients with multiple breaks.

Read on for some quick expert tips on choosing the most exact diagnosis codes for your rib fracture patients.

Use these Codes for Single-Rib Fractures

If your orthopedist performs an open treatment of a rib fracture, you'll report the procedure with 21811 (Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 1-3 ribs), confirms Peggy Stilley, CPC, CPC-I, CPMA, CPB, COGBC, revenue integrity auditor for Oklahoma Sports Orthopedics Institute in Norman.

When you're reporting a 21811 service, you'll likely be linking the CPT® code to an ICD-10 code in the S22.3--- code set, Stilley continues.

So, if the surgical notes indicate that the orthopedist performed open treatment on a single rib fracture, you'll likely choose from one of these ICD-10 codes as a diagnosis:

  • S22.31-- - Fracture of one rib, right side
  • S22.32-- - Fracture of one rib, left side
  • S22.39-- - Fracture of one rib, unspecified side.

Also: Be sure to add the appropriate seventh character to each code in the S22 category:

  • A - Initial encounter for closed fracture
  • B - Initial encounter for open fracture
  • D - Subsequent encounter for fracture with routine healing
  • G - Subsequent encounter for fracture with delayed healing
  • K - Subsequent encounter for fracture with nonunion
  • S - Sequela.

Note: If you don't have a fractured rib diagnosis for a 21811 service, you might not be coding correctly. Check with the provider and the payer if you're considering reporting 21811 without a rib fracture diagnosis code.

Multiple Fractures Lead to these Dx Codes

When your orthopedist performs open treatment on multiple rib fractures, there's a chance you'll still report 21811 - if he treats three ribs or fewer. For higher-count fracture fixes, however, you'll need to choose between 21812 (... 4-6 ribs) and 21813 (... 7 or more ribs).

The potential shift in CPT® coding will automatically necessitate a shift in diagnosis coding, explains Stilley.

For multiple rib fractures, you'll likely link the surgical code to a diagnosis code in the S22.4-- group, "depending on the laterality and number of fractures," says Stilley.

These ICD-10 codes are:

  • S22.41-- - Multiple fractures of ribs, right side
  • S22.42-- - Multiple fractures of ribs, left side
  • S22.43-- - Multiple fractures of ribs, bilateral
  • S22.49-- - Multiple fractures of ribs, unspecified side.

Seventh character concern: Remember, you'll need to include a seventh character - A, B, D, G, K, or S - to fully legitimize your multiple rib fracture diagnosis.


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