May 25, 2017

Question:
Can you help solve a diagnosis coding controversy we have? Occasionally, we have a patient who had a fracture and the Orthopedic Surgeon does the fracture repair. However, the Plastic Surgeon is asked to provide flap coverage to cover the open surgical wounds. What diagnosis codes should we use? I am thinking we use the fracture diagnosis code but we aren’t treating the fracture. Another coder says we should use an unspecified open wound code. We would appreciate your thoughts.

Answer:
Good question!  We agree that you would not use the fracture diagnosis code (S-) because you are not treating the fracture.  We also would not use the S- open wound diagnosis code because the open wound was not caused by trauma – it is an open surgical wound.  We recommend using and Z42.8 (Encounter for other plastic and reconstructive surgery following medical procedure or healed injury) as the primary diagnosis code.  The fracture diagnosis code can be listed as a secondary diagnosis.

*This response is based on the best information available as of 05/25/17.