The codes under M80 identify the site of the fracture. If a code that requires a 7th character is not 6 characters, a placeholder X must be used to fill in the empty characters. Exclusion: Diagnosis of colorectal cancer or total colectomy. One row has been completed as an example. It is very difficult on our older patients with vertebral compression fractures to decide whether they have pathological fractures due to osteoporosis or traumatic fractures.
Reminding adults who are new to insurance or don't use their plan's preventive benefits … 1, 2016, Premera will launch a new PersonalCare Partner Systems network that will support …. For purposes of the trauma program, we do not consider falls from standing height in older individuals to be traumatic fractures. If you've forgotten your username or password use our. As many as half of all women and a quarter of men older than 50 will break a bone due to osteoporosis. From your scenario, the patient in question was jumped upon by a dog how and how big are uncertain , but with sufficient force as to knock her against her sink whether she then fell to the floor is not noted , then I would say she had a Traumatic Wedge Vertebral Fracture of L1 S32. But insurance companies may view it differently. If you give more weight to the history of the injury, then I would go with the S Code for Traumatic Vertebral Fracture.
They are always so well thought out. Check in each month for a new discussion. A type 1 Excludes note is a pure excludes. To keep bones strong, eat a diet rich in calcium and vitamin D, exercise, and do not smoke. A code from category M80, not a traumatic fracture code, should be used for any patient with known osteoporosis who suffers a fracture — even if the patient had a minor fall or trauma — if that fall or trauma would not usually break a normal, healthy bone. To start viewing messages, select the forum that you want to visit from the selection below. Now let me give you one more perspective.
To view content sources and attributions, please refer to our. You might not know you have it until you break a bone. A type 2 Excludes note represents 'Not included here'. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. On September 12, 2010, Ms. The applicable 7th character is required for all codes within the category, or as the notes in the Tabular List instruct. Is this a pathological fracture due to osteoporosis or a traumatic fracture? Grace period: October 1, 2015 — September 30, 2016 ….
The site codes under category M80, Osteoporosis with current pathological fracture, identify the site of the fracture, not the osteoporosis. Having said that, for this particular scenario the presence of the osteoporosis is not confirmed in any way, so without a better hand on that I would be inclined to call it traumatic. If needed, medicines can also help. Is this a pathological fracture due to osteoporosis or a traumatic fracture? Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. In the United States, millions of people either already have osteoporosis or are at high risk due to low bone mass. A code from category M80, not a traumatic fracture code, should be used for any patient with known osteoporosis who suffers a fracture, even if the patient had a minor fall or trauma, if that fall or trauma would not usually break a normal, healthy bone.
It occurs commonly in women within 15-20 years after menopause, and is caused by factors associated with menopause including estrogen deficiency. If needed, medicines can also help. Respectfully submitted, Alan Pechacek, M. Primary osteoporosis can be of two major types: postmenopausal osteoporosis osteoporosis, postmenopausal and age-related or senile osteoporosis. I love reading your posts! To view all forums, post or create a new thread, you must be an. Wherever such a combination exists there is a 'use additional code' note at the etiology code, and a 'code first' note at the manifestation code.
For purposes of the trauma program, we do not consider falls from standing height in older individuals to be traumatic fractures. So how do coders differentiate the two types of fractures? She had an L1 compression fracture due to a fall against a sink from standing height, having been jumped on by a dog, and she has previously diagnosed alleged osteoporosis studies done elsewhere years ago, so we don't have the studies. If you think you may have a medical emergency, please call your doctor or 911 immediately. Screening or Therapy for Osteoporosis for Women Aged 65 Years and. While I tend to agree with the above assessment, the guidelines state: A code from category M80, not a traumatic fracture code, should be used for any patient with known osteoporosis who suffers a fracture, even if the patient had a minor fall or trauma, if that fall or trauma would not usually break a normal, healthy bone. We need some guidance, and we also need to know how the choice of codes affects reimbursement. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation.
However I think I would seek some clarification from the provider. Your bones become fragile and break easily, especially the bones in the hip, spine, and wrist. You might not know you have it until you break a bone. A bone mineral density test is the best way to check your bone health. Care for complications of surgical treatment of fracture repairs, occurring during the healing or recovery phase, should be coded with the appropriate complication codes.
So I go from the perspective that since the force of the impact was not described as excessive, like from a bull mastiff or equally sturdy animal, then I think a healthy person spine would not have fractured. Also, what are the reimbursement ramifications? They must be used in conjunction with an underlying condition code and they must be listed following the underlying condition. One case in point is the patient we currently have in the hospital. I would appreciate any and all feedback regarding this issue. For example, fractures sustained in a motor vehicle accident or falling off of a roof. These may not be required at this time for standard Medicare, but may be by her insurance, if not Medicare. For purposes of our trauma program, a patient like this wouldn't get in the registry because it would not be considered a traumatic fracture.
A bone mineral density test is the best way to check your bone health. Therefore given if there was documentation of osteoporosis, and given the guideline, I would go with the M80 code for osteoporotic fx. Therefore, I would still probably go with the Traumatic S Code S32. However I would go with the known facts of the patient's situation. Osteoporosis, pathological fracture, bone density tests.