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Part B Insider (Multispecialty) Coding Alert


Open Fracture May Not Require Use of Open Fracture Care Codes

Keep an eye on the full operative report -- not just the diagnosis codes -- to determine fracture care type. Question: Our orthopedic surgeon documented fracture care for an open scapula fracture, and our coder automatically assigned the open fracture care code, but I didn't think open fractures always required open treatment. Who is right? Answer: An open fracture (also referred to as a "compound fracture") occurs when a patient breaks his bone and the skin and has an open wound down to the fracture site. For such a fracture to the scapula, for example, you'd report 811.1x (Fracture of scapula; open) to describe the injury. Many coders mistakenly assume that open fractures always require open treatment, in which the physician makes a surgical incision to treat the fracture. If the orthopedic surgeon performs open fracture care at the scapula, you should report 23585 (Open treatment of scapular fracture [body, glenoid or [...]