Cracking the Code

Coding Greenstick Fractures

What is a greenstick fracture? A greenstick fracture occurs when a bone bends and cracks, instead of breaking into separate pieces. In this case the bone cracks on one side. It is called a “greenstick fracture” because the fracture itself looks like what happens when you try and break a small green branch on a tree. Most greenstick fractures occur in children under the age of 10. This is due to their bones being softer and more flexible than adult bones. These types of fractures have not been found to occur in adults. A greenstick fracture is a partial thickness fracture where only the cortex and periosteum crack on one side but remain uninterrupted on the other. Greenstick fractures occur most often in the fibula, tibia, ulna, radius, humerus, and clavicle.

Treatment of a greenstick fracture varies on severity. In most cases, they are treated by immobilizing the bone with a cast or splint. In severe cases, a provider may elect an open approach to expose the bone to insert a plate across the fracture site.

Q: A 5-year-old patient has a greenstick fracture of the right radial shaft. It is treated by surgically placing a bone plate on the distal radial shaft. What ICD-10-CM code is reported?
A: S52.311A Rationale: We look at our ICD-10-CM Alphabetic Index for Fracture, traumatic/radius/shaft/greenstick S52.31-. ICD-10-CM codes are specific for laterality (left, right) and the episode of care. We then turn our attention to the Tabular List and seven characters are needed to complete the code. The right radial shaft is indicated and because the encounter is being treated surgically, this meets the definition of initial encounter or active treatment (See ICD-10-CM guideline I.C.19.a.).
Reference: FY 2022 ICD-10-CM Coding Guidelines, MAYO Clinic
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