The terms closed and open are major players for traumatic fracture diagnosis coding. Brush up on some basics with this focus on ICD-10-CM coding for rib fracture initial encounters.
First, Find Fractures in the Index — You Know You Should!
The ICD-10-CM index provides these entries for rib under the Fracture heading:
- Rib S22.3-
- With flail chest – see Flail, chest
- Multiple S22.4-
- With flail chest – see Flail, chest.
Turn to the Tabular to See Crucial Note and Complete Codes
Important note: If you turn to category S22.- in your book or online coding resource, you’ll see a can’t-miss note for accurate open/closed fracture coding: “A fracture not indicated as open or closed should be coded to closed.”
An open fracture is one where the bone punctures the skin or there is a significant break in the skin (not an abrasion or superficial laceration) at the fracture site. A closed fracture does not break the skin. Let providers know that inadequate documentation will result in you reporting a closed fracture because of this rule.
Codes: For our rib diagnoses, remember that the index pointed us to S22.3- and S22.4-.
One rib: Subcategory S22.3- (Fracture of one rib) divides into further subcategories:
- S22.31- (right side)
- S22.32- (left side)
- S22.39- (unspecified side).
To complete the codes for initial encounters, you need one of these seventh characters (note that I’ve omitted subsequent and sequela seventh character options here):
- A (Initial encounter for closed fracture)
- B (Initial encounter for open fracture).
Multiple ribs: Subcategory S22.4- (Multiple fractures of ribs) also subdivides based on side, with the addition of a bilateral option:
- S22.41- (right side)
- S22.42- (left side)
- S22.43- (bilateral)
- S22.49- (unspecified side).
S22.4- has the same seventh character options as S22.3-, meaning that you need to know whether the fracture is open or closed to accurately code the initial encounter diagnosis.
What About Flail Chest?
Remember the index said that if the rib fractures were with flail chest, you should check “Flail, chest.” That index entry shows you should use S22.5- for flail chest or P13.8 for newborn (birth injury).
For S22.5-, you have those same seventh character options that apply to all codes in S22.-, so you aren’t off the hook when it comes to knowing whether the fracture is open or closed for a flail chest initial encounter diagnosis.
2 Bonus Tips: Treatment and Official Guidelines
Treatment: Don’t confuse open/closed fracture diagnoses with open/closed fracture treatment. Open treatment means the surgeon used an open incision to get to the fractured rib. Closed treatment may involve manipulating the fracture from outside the body to ensure realignment or taping or strapping.
OGs: This instruction from the ICD-10-CM official guidelines is not about ribs, but it’s good to know as part of increasing your open/closed fracture knowledge: “The open fracture designations in the assignment of the 7th character for fractures of the forearm, femur and lower leg, including ankle are based on the Gustilo open fracture classification. When the Gustilo classification type is not specified for an open fracture, the 7th character for open fracture type I or II should be assigned (B, E, H, M, Q).”
What About You?
What terms do you see in fracture documentation that clue you in to closed vs. open?
——————————————————
Photo courtesy of: TCI SuperCoder
Originally Published On: TCI SuperCoder
Follow Medical Coding Pro on Twitter: www.Twitter.com/CodingPro1
Like Us On Facebook: www.Facebook.com/MedicalCodingPro
