Forum - Questions & Answers

Oct 27th, 2015 - cmgmr 4 

Fracture code

I need help in determining why the following code is incorrect:

Child has a displaced comminuted fracture of shaft of radius right arm, initial encounter in Emergency Room

Code - S52.351A

What makes this code incorrect? I'm just not seeing it!

Oct 27th, 2015 - LBAROGIANIS 250 

re: Fracture code

Maybe they are looking for more information. I was told on injury claims we need at least 4 codes. I could be wrong.

ICD-10 Code Examples
Example 1: A left knee strain injury that occurred on a private recreational playground when a child landed incorrectly from a trampoline:
Injury: S86.812A, Strain of other muscle(s) and tendon(s) at lower leg level, left leg, initial encounter
External cause: W09.8xxA, Fall on or from other playground equipment, initial encounter
Place of occurrence: Y92.838, Other recreation area as the place of occurrence of the external cause
Activity: Y93.44, Activities involving rhythmic movement, trampoline jumping

Oct 27th, 2015 - Codapedia Editor 1,399 

re: Fracture code

What makes you think it is incorrect? it is a valid code. Does it describe the patient's injury?

Did you get a denial?

The external cause codes are "optional" per ICD-10 general guidelines, but your payer may require them.

There are three additional occurrence codes. I don't recommend using them, again, unless your payer requires them. I have heard that payers are requiring an external cause code, but have not heard of anyone requiring occurrence codes.
Good luck

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