ICD-10 Coding for History of Fracture(Z87.81, Z87.311)
Complete ICD-10-CM coding and documentation guide for History of Fracture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to History of Fracture
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| Z87.81 | Personal history of (healed) traumatic fracture | Use when the patient has a history of a healed traumatic fracture and it is relevant to the current encounter. |
|
| Z87.311 | Personal history of (healed) pathological fracture | Use when the patient has a history of a healed pathological fracture and it is relevant to the current encounter. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for history of fracture
Essential facts and insights about History of Fracture
Primary ICD-10-CM Codes for history of fracture
Decision Criteria
clinical Criteria
- Fracture is fully healed with no active treatment.
Applicable To
- Healed traumatic fracture
Excludes
- Current traumatic fracture (S00-T88)
Clinical Validation Requirements
- Documentation of healed status
- Imaging reports confirming fracture healing
Code-Specific Risks
- Incorrectly using for active fractures
Coding Notes
- Ensure documentation specifies 'healed' and the fracture type.
Z87.311 - Personal history of (healed) pathological fracture
Use when the patient has a history of a healed pathological fracture and it is relevant to the current encounter.
Applicable To
- Healed pathological fracture
Excludes
- Current pathological fracture (M80-M85)
Clinical Validation Requirements
- Documentation of healed status
- Underlying condition documented (e.g., osteoporosis)
Coding Notes
Ensure documentation specifies 'healed' and the underlying condition.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Other postprocedural states
Z98.898Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting History of Fracture to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z87.81.
Impact
Clinical: Inaccurate patient history, Regulatory: Potential audit issues, Financial: Incorrect billing
Mitigation Strategy
Use templates, Educate staff on documentation standards
Impact
Reimbursement: May result in incorrect DRG assignment., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Use S00-T88 codes for active fractures.
Impact
Using history codes for active fractures.
Mitigation Strategy
Regular training and audits.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for History of Fracture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for History of Fracture
Use these documentation templates to ensure complete and accurate documentation for History of Fracture. These templates include all required elements for proper coding and billing.
Orthopedic follow-up for healed fracture
Specialty: OrthopedicsRequired Elements
- Healed status
- Fracture type
- Location and laterality
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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