ICD-10-CM 7th Character with Fractures Explained https://www.cco.us/icd-10-cm-diagnostic-coding-course
Alicia: If you're ready, I'll get a drink and we'll hit the first one. ICD-10-CM and Fractures... One of the unique things about ICD-10-CM and Fractures is you're able to teach a lot of concepts in ICD-10 with fractures like in ICD-9 diabetes. We could use diabetes to bring out several scenarios and cases, so fractures there's some good points to bring up.
Q: Open fracture coding in ICD-10-CM use a 7th character to explain the severity. How is this 7th character determined?
A: Let's go talk about that, ICD-10-CM 7th Character with Fractures. Now, the one thing that most of you probably already know if you're working with ICD-10-CM is the fact that you're able to have up to 7 characters and they're not called digits like they were with ICD-9 they're called characters; so the 7th is going to be that last digit. Usually it is to indicate whether it's an initial encounter or a subsequent encounter or maybe sequela which stands for late effect. But with the fractures, this 7the character -- oh, not only tells if it's an initial encounter or a subsequent encounter it also is going to use a classification system called The Gustilo-Anderson Classification System, and it gives you two vital pieces of information.
One is: what is the likelihood of your patient developing an infection because it's an open fracture.
Now, if you're not familiar what the difference between a closed and an open fracture is, an "open" simply means the skin is open; there is an open wound, and most of the time the bone has caused that. It has poke through leaving the door for infection. And because the bones run out throughout your entire body, if you get an infection in the bone and you've got blood parts that are made in the bone marrow, it can be a really big time, bad thing real fast. So, it's something that they take seriously and they are very cautious with.
1) What's the likelihood that this is going to cause an infection? 2) How long is it going to take for that fracture to heal? Now, there's kind of a standard on fractures. If it's just a simple fracture, but if it's a compound or an open fracture chances are you're looking at pins and things and some surgery to debride or clean that area up, so we could take a little bit longer. It usually means it's a more severe fracture if it's actually broken through the skin.
As the grade goes up on this classification system, the infection rate rises dramatically, and lengthens the time for the fracture to heal. Because you know most of the time a person doesn't have to take antibiotics if they've got a fracture, but if you've got an open fracture you're most likely to be on antibiotic.
Grade I open fracture injury, let's say of the tibia has less than 2% infection rate (with proper treatment), and takes an average of about 4-5 months to heal. But, if you move down to Grade IIIB and IIIC (which I'm going to break this down for you), fractures have up to 50% infection rate and takes an average of 8-9 months for bone healing. That's a huge difference.
Let's see what divides these types up: Type I - is simply that the wound is 1 cm. Then, you've got type II is 1-10cm. We're talking centimeters not inches, so keep that in mind. Then, type III A, we have greater than 10 cm, high energy (meaning it was a high energy break, the impact, or however you want to say that) and adequate tissue for coverage. There's adequate tissue to cover and stitch that all back up for that open wound.
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