Dr. Smith sees a 23-year-old male with a right hand injury. The patient was at a bar last night and hit another patron in the mouth. He has pain at the right 5^th metacarpal phalangeal (MCP) joint and a small laceration. History is otherwise negative. Physical exam reveals a 1cm laceration over the right 5^th MCP, no surrounding redness or discharge, but the joint is tender with passive range of motion. Tetanus is updated and IV antibiotics given. X-ray shows a boxer’s fracture with displacement and no foreign body. An Orthopedics is consulted.

Dr. Smith records a diagnosis of “fight bite.” Orthopedics decides to take the patient to the operating room for irrigation of the wound and repair of the open fracture.

ICD-10 requires a higher degree of specificity to correctly code orthopedic and hand injures. In this example, it would be important to document where and how the injury occurred, and whether alcohol was a contributing factor. The precise location of the fracture, including which hand, which finger, and which phalange are all needed for accurate coding of the encounter.

In this example, it would be better for the ED physician to diagnose “open, displaced fracture of right 5^th metacarpal bone.”

The ED coder would assign the following ICD-10 diagnosis codes:

S62.336B	(Displaced fracture of the neck of fifth metacarpal bone, right hand, initial visit for open fracture)
S61.451A	(Open bite of right hand, initial encounter) to describe the mechanism of injury.

For the Evaluation & Management service, the coder would also assign a CPT code such as 99284. 

For additional information on ICD-10 coding for emergency medicine, visit the ACEP Reimbursement page.

08/2015