They are open to changing if I can give them some literature that it is standard of practice to do this. My orthopedic physicians don't feel comfortable stating 'pathologic fracture due to osteoporosis' if they don't have a dexascan or other definitive diagnosis for the osteoporosis. To: Pathologic fracture due to osteoporosis without a dexascan.how do you handle? This guidance clearly directs the coder to assign the code for "pathological fracture," supporting an assumed cause-effect relationship between "fracture" and "osteoporosis." This represents the type of advice that is based on Coding Clinic advice over the years, and it is certain that coders and documentation specialists will welcome this explicit direction from the AHA because it averts the need for a provider query. 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. The codes under M80 identify the site of the fracture. In ICD-10-CM, however, this cause-effect relationship is assumed, supported by the following guidance from the ICD-10-CM Official Guidelines for Coding and Reporting (I.C.13.d.2):Ĭategory M80, Osteoporosis with current pathological fracture, is for patients who have a current pathologic fracture at the time of an encounter. Without this link, the CDI specialist or coder must query the physician. In other words, the terms "fracture" and "osteoporosis" documented on the same record do not equate to a diagnosis of "pathological fracture." A physician must clearly document this cause-effect relationship with terms such as "osteoporotic fracture", "fracture due to/associated with osteoporosis", or similar language. Currently, there is not an "assumed" cause-effect relationship in ICD-9-CM between an acute (i.e., new) fracture and osteoporosis. One example is how to correctly code a case in which the patient has both osteoporosis and a current pathological fracture. The 2012 ICD-10-CM Official Guidelines for Coding and Reporting contains advice regarding the proper application of diagnosis codes from specific code categories. Guidance varies regarding cause-and-effect relationship In ICD-10 Pathologic is now an assumed link, Subject: I saw your question about pathologic fracture on the CDI talk site. But the situations I am asking about is when there is NO prior confirmed diagnosis of osteoporosis. I do understand from below which was sent as a response (thank you!), that if the osteoporosis was previously diagnosed that a link would be assumed with icd10. If so, does anyone have any literature to support this? My physicians are wanting to see some literature before they would begin this. Thoughts? Any literature to support either side out there? Would it be appropriate without a confirmed diagnosis.and just based on the mechanism being GLF in pt >50 yrs old to state Pathological fracture due to possible Osteoporosis? aren't sure that you can and aren't comfortable doing that. My orthopedic physician assistant felt that based on the 'Own the bone' etc literature that you could presume osteoporosis based on mechanism of injury.without any other definitive diagnostic test to confirm osteoporosis. There has never been a Dexascan to confirm the diagnosis.Įxample: Pt 54 has ground level fall and fractures hip. when there is NO definitive diagnosis of Osteoporosis prior to the fracture. My question is, Can (Is it appropriate/standard of practice) a physician document 'pathologic fracture due to Osteoporosis'. I think I didn't ask the question well initially. Thanks for taking the time if you have any information. I had put this question out previously and thought I would put this out there again. Hi all, Hoping someone can help me with this.
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