Fractures of the proximal femur or hip are quite common in elderly, osteoporotic patients. While many of them are clinically and radiologically obvious, there are fractures more difficult to diagnose. Sometimes, repeat X-ray, CTs and MRIs may be required to confirm the diagnosis. Apart from the complications in establishing the diagnosis, reporting hip fractures is also challenging with ICD-10 medical coding as it requires more specificity and more details.
Hip fractures either involve bone enveloped by the ligamentous hip joint capsule (intracapsular) or the bone below the capsule (extracapsular). There are separate ICD-10 codes for intracapsular and extracapsular fractures.
Intracapsular Fractures
Intercapsular fractures are termed as fractures of the ‘neck of femur’ (NOF) which include fractures below the femoral head (subcapital), across the mid-femoral neck (transcervical) or fractures across the base of the femoral neck (basicervical). You need to choose an appropriate code that reflects the type of fracture (open or closed), laterality (left or right), episode of care (initial, subsequent and sequela) and complications (delayed healing, non-union, malunion). Some of the ICD-10 codes are given below.
- S72.012K: Unspecified intracapsular fracture of left femur, subsequent encounter for closed fracture with nonunion
- S72.012M: Unspecified intracapsular fracture of left femur, subsequent encounter for open fracture type I or II with nonunion
- S72.012N: Unspecified intracapsular fracture of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
Extracapsular Fractures
Extracapsular fractures include intertrochanteric (between the trochanters) and subtrochanteric (distal to the trochanters). Such fractures do not involve the neck of the femur. Here also, you should consider the type of fracture, laterality and episode of care. There are separate codes for intertrochanteric and subtrochanteric. Some of them are given below.
Intertrochanteric
- S72.141A: Displaced intertrochanteric fracture of right femur, initial encounter for closed fracture
- S72.141B: Displaced intertrochanteric fracture of right femur, initial encounter for open fracture type I or II
- S72.141C: Displaced intertrochanteric fracture of right femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
- S72.141D: Displaced intertrochanteric fracture of right femur, subsequent encounter for closed fracture with routine healing
Subtrochanteric
- S72.21XA: Displaced subtrochanteric fracture of right femur, initial encounter for closed fracture
- S72.21XB: Displaced subtrochanteric fracture of right femur, initial encounter for open fracture type I or II
- S72.21XC: Displaced subtrochanteric fracture of right femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
- S72.21XD: Displaced subtrochanteric fracture of right femur, subsequent encounter for closed fracture with routine healing
You should also consider the complications associated with intertrochanteric (rarely, nonunion or malunion, degenerative changes) and subtrochanteric (high rates of nonunion and implant, fatigue as a result of high physical stress in the region) to ensure correct coding and quick reimbursement. Consider partnering with certified and professional medical coding experts, if needed.
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