I remember back in the day when I first started coding, I had no clue what some of the different fracture types meant or even looked like. (Keep in mind this was a gazillion years ago and we did not use Google or the internet – we didn’t even have them for that matter)!  As time evolved and I looked at x-rays with my providers, I was able to see what some of them looked like.  As much as I hate to admit it, I am now thankful that the tools we have today exist at our fingertips!

Fracture care may seem straightforward, but many coders struggle and/or get confused when it comes to the different types of fractures and how to code for them. I think knowing the anatomy, what the fractures look like, what the different terms mean, and what to look for in the documentation help tremendously.

There are several types of fractures: transverse, oblique, spiral, comminuted, avulsed, segmental, impacted, torus, and greenstick being the most common ones. Here is a chart to help you with a visual of what each looks like.

Knowing the different kinds of fractures is only a small piece of the bigger picture of fracture coding.  To properly code fractures, I always ask myself several questions.   Here are some of the questions that pop into my head when I am reading an operative note.  This is not all-inclusive because as we all know, each operative note is different and never the same (or shouldn’t be).

1. Is this an open or closed fracture?
2. If it was closed, did they do a manipulation?
3. If it was open, did they do any type of debridement that will allow me to add the fracture debridement code?
4. What kind of fracture is it?
5. What body part is fractured?
6. Is it proximal, distal, shaft—exactly where is the fracture?
7. Was any hardware used? If yes, what kind?  Was it internal fixation, external fixation, or both?

Again, that is not an all-inclusive list of questions I ask myself, but it’s certainly a good start. If you’re saying “hmm” when you are coding fractures in CPT, join me in my webinar CPT Coding for Fractures.  I will be discussing some of the most common types of fractures as well as some tips I have learned from my years of coding fractures!