Approximately 6.8 million patients in the U.S. obtain medical attention for fractures each year. Fractures account for 16% of all musculoskeletal injuries. Annually, close to 3.5 million visits are made to emergency departments for fractures, resulting in roughly 887,679 hospitalizations. [i]

Correct coding tips for fractures and external causes

In August 2017 a webinar addressing coding guidelines for fractures and external causes was presented by Nena Scott, MSEd, RHIA, CCS, CCS-P, CCDS, Director of Coding Quality and Professional Development at TrustHCS. An overview of the anatomy of the skeletal system was covered, as well as coding guidelines for coding of traumatic fractures and external causes of morbidity.

Four Principles of Traumatic Fracture Coding

  1. Multiple coding of injuries should be followed when coding fractures.
  2. Fractures of specified sites are coded individually by site in accordance with both the provisions within categories S02, S12, S22, S32, S42, S49, S52, S59, S62, S72, S79, S82, S89, S92, S99 and the level of detail furnished by medical record content.
  3. If a fracture is not indicated as open or closed, it should be coded as closed.
  4. If it is not indicated whether a fracture is displaced or not displaced, it should be coded as displaced.

Initial vs. Subsequent Encounters – The appropriate 7th character should be used to designate whether the patient is being seen for an initial or subsequent encounter.

Fractures due to osteoporosis – 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.

Seven External Cause Coding Guidelines

  1. Assign the external cause code with the appropriate 7th character (initial encounter, subsequent encounter or sequela) for each encounter for which the injury or condition is being treated.


  1. Use the full range of external cause codes to completely describe the cause, intent, place of occurrence, and if applicable, the activity of the patient at the time of the event as well as the patient’s status for all injuries and other health conditions due to an external cause.


  1. Assign as many external cause codes as necessary to fully explain each cause. If only one external code can be recorded, assign the code most related to the principal diagnosis.


  1. The selection of the appropriate external cause code is guided by the Alphabetic Index of External Causes and by Inclusion and Exclusion notes in the Tabular List.


  1. An external cause code can never be a principal diagnosis.


  1. Certain external cause codes are combination codes that identify sequential events that result in an injury, such as a fall which results in striking against an object. The injury may be due to either event or both. The combination external cause code used should correspond to the sequence of events regardless of which caused the most serious injury.


  1. An external cause code from Chapter 20 is not needed if the external cause and intent is included in a code from another chapter, e.g. T36.0X1-Poisoning by penicillin, accidental (unintentional).


Multiple External Cause Coding Guidelines

More than one external cause code is required to describe the external cause of an illness or injury. If two or more events cause separate injuries, an external cause code should be assigned in the following priority:

Type of Injury Priority
Child and Adult Abuse Takes priority over all other external cause codes
Terrorism Takes priority over all other external cause codes except child and adult abuse
Cataclysmic Events Takes priority over all other external cause codes except child and adult abuse and terrorism
Transport Accidents Takes priority over all other external cause codes except child and adult abuse, terrorism and cataclysmic events


The complete presentation audio recording is available by clicking here and PDF of the slides may be accessed here.