A: Proximal shaft means the upper end of the shaft, but not quite to the proximal end of the bone. A fracture of the proximal shaft is coded as a shaft fracture.
Q: If a patient with osteoporosis trips and falls and fractures her hip, is this coded as a pathological or traumatic fracture?
A: Fractures sustained in a manner that normally wouldn’t break a healthy bone are coded as pathological fractures. When the documentation is unclear, query the provider for clarification (Source: Coding Clinic, Second Quarter 2018).
Q: How is Kiva® kyphoplasty coded?
A: Kiva® kyphoplasty is coded using the root operation Supplement. Unlike conventional kyphoplasty where a balloon is inserted percutaneously into the vertebral body and inflated, followed by injection of bone cement into the void left by the inflated balloon, a Kiva® kyphoplasty is an implant with bone cement that is inserted into the vertebral body and left in place. There is no separate objective to reposition the vertebra, so no Reposition code is used.
Q: What is the 7th character for a fracture when the patient is admitted for ORIF 2 weeks after injury? In this case, the surgery was delayed to allow swelling to go down.
A: This is still coded as initial because the patient is receiving active treatment for the fracture. The fracture is not yet in the healing phase.
Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer
Kristi also performs DRG and APC audits and is known for her vast knowledge on coding vascular interventional radiology procedures. Kristi has an extensive background in coding education and consulting and is a national speakers on topics related to ICD-10 and CPT coding as well as code-based reimbursement.