Question

Amy Stuart is a 45 year old female who presents to ED with a right forearm fracture after falling while walking her dog. She was walking on the sidewalk in her neighborhood and accidently tripped and fell. She has an x-ray in the ED and is found to have a displaced compound comminuted fracture of the radial shaft. It is a type II open fracture. She also reports that she hit her head when she fell. ED examination confirms a slight concussion but patient reports no loss of consciousness. The patient is admitted and stabilized and scheduled for surgery. She is transferred out on day 2 from Pleasantville Hospital.

1) Assign the ICD-10-CM Diagnosis(es) – be sure to clearly indicate the PRINCIPAL dx!

2) Assign the POA indicators for this case

Answer 1

1. * ICD-10-CM CODE for Displaced compound comminuted type II open fracture of right radial shaft - S52 . 301B

* Concussion without loss of consciousness- S06 . 0X0A - Principal dx.

2. POA indicators

* Displaced compound comminuted type II open fracture of right radial shaft- Y

* Concussion without loss of consciousness- Y