Before you report an ICD-10-CM code for a patient with osteoporosis who has broken a bone, take a moment to make sure you’ve applied these three (and a half) tips for more accurate coding.
1. Take a Break From Coding Site (Unless There’s a Break)
Site is not a component of M81.- (Osteoporosis without current pathological fracture) because osteoporosis is a systemic condition, meaning it isn’t limited to just one site.
In contrast, M80.- (Osteoporosis with current pathological fracture) does list sites, but the site tells you where the fracture is.
Source: You’ll find this information in the ICD-10-CM Official Guidelines for Coding and Reporting (OGs), FY 2019, section I.C.13.d.
2. Watch Timing of Fracture for Correct Coding
Pay attention to the word “current” in M81.- (Osteoporosis without current pathological fracture). If there’s no current fracture, but there was one in the past, you should report Z87.310 (Personal history of (healed) osteoporosis fracture).
Source: This rule is in the OGs (section I.C.13.d.1), but a “use additional code” note under M81.- in the ICD-10-CM Tabular also gives you this important instruction.
3a. Don’t Assume Trauma Equals Traumatic Fracture
When a patient with osteoporosis fractures a bone after a minor trauma, pause before you code. “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.”
Source: The OGs are your go-to source again. This time, check section I.C.13.d.2.
3b. Don’t Assume Trauma Does NOT Equal Traumatic Fracture
The previous tip offers good advice to help you deal with the real-world situation of coding for a fracture from a minor fall or trauma when the patient has osteoporosis. But when it comes time to apply that advice, you’re likely to hit a snag. How do you know for sure that you should use an M80.- code when there has been a fall? The answer is that the documentation needs to tell you whether you’re dealing with an osteoporotic pathologic fracture. If the documentation is not clear, query the provider.
Source: The advice to confirm with the provider is in AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS, 2018, vol. 5, no. 2, “Osteoporosis and Fracture (Traumatic versus Pathologic).”
What About You?
What areas do you think need to be clarified to simplify coding for patients with osteoporosis? Do you think the current ICD-10-CM codes are adequate for reporting osteoporotic fractures?