Should the fracture be coded as pathological or as the result of trauma?
X-rays show advanced osteoporosis, separation of the acetabulum, and crumbling fracture of head of the left femur. The new codes are as follows:Īfter walking out of a nursing home and falling off the curb, an 89 year old woman, with a history of severe osteoporosis, is admitted to the hospital for a fractured left hip. External cause of injury codes (E-codes) may be used if the pathologic fracture follows minor trauma to identify the nature of this trauma.
PATHOLOGICAL FRACTURE DEFINITION CODE
Codes from 800-829 for traumatic fractures should never be used with a code from this category. X-ray indications of diseased bone may be used by the physician to arrive at a diagnosis of a pathologic fracture, but should not be used by coders to make this determination.įifth digits have been added to category 733.1, Pathologic fracture, to allow identification of the site of the fracture. Only the physician can make the determination that the fracture is out of proportion to the degree of trauma. Basically it is up to the physician to make the determination if the fx is out of proportion to the degree of trauma.Ī pathologic fracture is defined as a break in a diseased bone due to weakening of the bone structure by pathologic processes (such as osteoporosis or bone tumors) without any identifiable trauma or following only minor trauma. However the following is from CC 4th Qtr 1993.
I don’t know that CMS has a definition for pathological fracture.
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