EmailPeri-prosthetic fracture of femur
Publication Date: September 2004
ICD 10 AM Edition: Fourth edition
Retired Date: 30/6/2010
Query Number: 1980
A patient presented with a peri-prosthetic fracture of the right proximal femur following an unspecified fall. A hemiarthroplasty for the initial fracture of the right femur was performed three weeks previously.
Could the Committee please advise on the correct coding of peri-prosthetic fracture of the right proximal femur occurring after the patient had an unspecified fall.
I have used the codes:
'M96.69 Fracture of bone following insertion of orthopaedic implant, joint prosthesis or bone plate'
'S72.40 Fracture of lower end femur'
(external codes)
'W19 Unspecified fall'
'Y92.22 Health service area'
If the code M96.69 can not be used in this scenerio could the Committee please advise when the code M96.69 can be used?
Could the Committee please advise on the correct coding of peri-prosthetic fracture of the right proximal femur occurring after the patient had an unspecified fall.
I have used the codes:
'M96.69 Fracture of bone following insertion of orthopaedic implant, joint prosthesis or bone plate'
'S72.40 Fracture of lower end femur'
(external codes)
'W19 Unspecified fall'
'Y92.22 Health service area'
If the code M96.69 can not be used in this scenerio could the Committee please advise when the code M96.69 can be used?
Response
As this fracture was sustained as a result of a fall, it should be assigned a code from the injury chapter. M96.6 Fracture of bone following insertion of orthopaedic implant, joint prosthesis or bone plate should be reserved for fractures that occur during surgery, or are due to the presence of the device. In this scenario, refer to the lead term 'Fracture':
S72.8 Fractures of other parts of femur
Z96.64 Presence of hip implant (if meets ACS 0002 Additional diagnoses)
W19 Unspecified fall'
Y92.9 Unspecified place of occurrence
U73.9 Unspecified activity
NCCH query Q1527 advises that 'M96.6 Fracture of bone following insertion of orthopaedic implant, joint prosthesis, or bone plate should be assigned only when a fracture (and no other type of complication) is a result of the insertion or presence of these devices.’
The code M96.6 Fracture of bone following insertion of orthopaedic implant, joint prosthesis, or bone plate is referenced in the index under the lead term 'Complication'.
It was noted that the inquirer described the fracture as being of the proximal femur, however the suggested code was a fracture of the lower end of the femur. The inquirer should verify the site of the fracture, and code accordingly. It was also noted that Y92.22 Health service area would not be the correct place of occurrence, as this corresponds to the diagnosis code instead of the external cause code. Refer to Victorian Coding Newsletter, May 2003 article ‘Place Of Occurrence Codes For External Causes Related To Surgical/Medical Care’.
S72.8 Fractures of other parts of femur
Z96.64 Presence of hip implant (if meets ACS 0002 Additional diagnoses)
W19 Unspecified fall'
Y92.9 Unspecified place of occurrence
U73.9 Unspecified activity
NCCH query Q1527 advises that 'M96.6 Fracture of bone following insertion of orthopaedic implant, joint prosthesis, or bone plate should be assigned only when a fracture (and no other type of complication) is a result of the insertion or presence of these devices.’
The code M96.6 Fracture of bone following insertion of orthopaedic implant, joint prosthesis, or bone plate is referenced in the index under the lead term 'Complication'.
It was noted that the inquirer described the fracture as being of the proximal femur, however the suggested code was a fracture of the lower end of the femur. The inquirer should verify the site of the fracture, and code accordingly. It was also noted that Y92.22 Health service area would not be the correct place of occurrence, as this corresponds to the diagnosis code instead of the external cause code. Refer to Victorian Coding Newsletter, May 2003 article ‘Place Of Occurrence Codes For External Causes Related To Surgical/Medical Care’.
