Fractures, Sprains, Strains and Dislocations Except Femus, Hip, Pelvis and Thigh


MS-DRG	CMS DRG (Prior to 10/1/2007)
562	Fractures, Sprains, Strains and Dislocations Except Femur, Hip, Pelvis and Thigh with MCC	253	Fractures, Sprains, Strains and Dislocations of Upper Arm and Lower Leg Except Foot, Age >17 with CC
563	Fractures, Sprains, Strains and Dislocations Except Femur, Hip, Pelvis and Thigh without MCC	254	Fractures, Sprains, Strains and Dislocations of Upper Arm and Lower Leg Except Foot, Age >17 without CC

The below listed fractures, sprains, strains and dislocations except femur, hip, pelvis, and thigh hip are not inclusive. The coder should refer to the applicable Coding Clinic guidelines for additional information. The Centers for Medicare and Medicaid Services considers Coding Clinic, published by the American Hospital Association, to be the official source for coding guidelines. Hospitals should follow the Coding Clinic guidelines to assure accuracy in ICD-9-CM coding and DRG assignment.

Definition of Principal Diagnosis

The principal diagnosis is that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.

Two or more diagnoses may equally meet the definition for principal diagnosis. This is in terms of the circumstances of admission, diagnostic work-up and/or therapy provided. Be aware that there is a difference between admitting a patient to treat two conditions and two conditions being present at the time of admission. The principal diagnosis is always the reason for admission.

Documentation to Support the Principal Diagnosis

When reviewing these charts, determine if the principal diagnosis was the reason for the admission and treatment. If there was more than one reason for admission and treatment, determine if the diagnosis selected as the principal diagnosis was the diagnosis that received the emphasis of treatment in terms of the circumstances of admission, diagnostic work-up and therapy provided. (See "Guidelines for Selection of Principal Diagnosis," Coding Clinic, second quarter 1990, pages 3-12.)

Principal Procedure

"The principal procedure is one that was performed for definitive treatment rather than one performed for diagnostic or exploratory purposes, or was necessary to take care of a complication. If two procedures appear to meet this definition, then the one most related to the principal diagnosis should be selected as the principal procedure." (See Coding Clinic, fourth quarter 1990, page 5.)

Significant Procedure

A significant procedure as defined by the Uniform Hospital Discharge Data Set is one that is surgical in nature, carries a procedural or anesthetic risk or requires specialized training. (See Coding Clinic, fourth quarter 1990, page 5.)

Types of Fractures

A closed fracture is a fracture that does not produce an open wound in the skin.

An open fracture is a fracture in which a wound, through the adjacent or overlying soft tissues, communicates with the site of the break.

Most Common Codes

717.0 - Tear, meniscus, medial, bucket handle

*717 - Internal derangement of the knee

*717.4 - Derangement of lateral meniscus

717.5 - Derangement of meniscus, not elsewhere classified

717.7 - Chondromalacia of patella

*717.8 - Other internal derangement of knee

717.9 - Unspecified internal derangement of knee

718.01 - Disorder, cartilage, articular, shoulder region

718.02 - Disorder, cartilage, articular, upper arm

718.07 - Disorder, cartilage, articular, ankle and foot

718.21 - Dislocation, pathological shoulder region

718.22 - Dislocation, pathological, upper arm

718.26 - Dislocation, pathological, lower leg

718.27 - Dislocation, pathological, ankle and foot

718.31 - Dislocation, recurrent, joint shoulder region

718.32 - Dislocation, recurrent, joint, upper arm

718.36 - Dislocation, recurrent, joint, lower leg

718.37 - Dislocation, recurrent, joint, ankle and foot

754.41 - Congenital dislocation of the knee

*810 - Fracture, clavicle

811.00 - Fracture, closed, scapula, unspecified part

811.01 - Fracture, closed, scapula, acromial process

811.02 - Fracture, closed, scapula, coracoid process

811.03 - Fracture, closed, scapula, glenoid cavity and neck

811.10 - Fracture, open, scapula, unspecified part

811.11 - Fracture, open, scapula, acromial process

811.12 - Fracture, open, scapula, coracoid process

811.13 - Fracture, open, scapula, scapula, glenoid cavity and neck

*812 - Fracture, humerus

*818 - Fractures, ill-defined, upper limb

*822 - Fracture, patella

*823 - Fracture, tibia and fibula

*824 - Fracture, ankle

825.0 - Fracture, closed, calcaneous

*827 - Fracture, other, multiple and ill-defined, lower limb

*831 - Dislocation, shoulder

*832 - Dislocation, elbow

*836 - Dislocation, knee

*837 - Dislocation, ankle

*840 - Sprains and strains, shoulder and upper arm

*844 - Sprains and strains, knee and leg

*845.0 - Sprains and strains, ankle

* Indicates a code range

Documentation

Care should be exercised in assigning combination codes for multiple fractures, making sure that the available specificity as to bones sites involvement and type of fractures (open or closed) are not compromised by the use of a single code.
Combination categories for multiple fractures are provided for use when there is insufficient detail in the medical record (such as trauma cases transferred to another hospital).
Fractures of specified sites are coded individually by site in accordance with both the provisions within categories 800-829 and the level of detail furnished by medical record content.
Fracture-dislocation of right or left elbow involving displaced olecranon and right Colles' fracture are coded 813.01 and 813.41.
Multiple fractures of the same limb classifiable to the same three-digit or four-digit category are coded to that category.
Multiple unilateral or bilateral fractures of the same bone(s) but classified to different fourth-digit subdivisions (bone part) within the same three-digit category are coded individually by site.
Multiple fracture categories 819 and 828 classify as bilateral fractures of both upper limbs (819) and both lower limbs (828), but without any detail at the fourth-digit level other than open and closed type of fractures.
Multiple fractures are sequenced in accordance with the severity of the fracture. The physician should be asked to list the fracture diagnoses in the order of severity.
Comminuted T-shaped fracture of the right humerus with closed fracture-dislocation of the left shoulder is coded 812.44 and 812.03.
When it is necessary to use any of the combined codes for multiple fractures, the following order of priority for sequencing purposes may be followed:
- 1st, Multiple fractures involving skull or face with other bones (804.0-804.9).
- 2nd, Ill-defined fractures involving bones of pelvis or vertebral column with other bones, excluding those of face and skull (809.0, 809.1).
- 3rd, Multiple fractures involving both lower limbs, lower with upper limb, and lower limb(s) with rib(s) and sternum (828.0, 828.1).
- 4th, Multiple fractures involving both upper limbs, and upper limb with rib(s) and sternum (819.0, 819.1).
- 5th, Ill-defined fractures of trunk (809.0, 809.1)