Osteoporotic Fractures Often Undercoded or Miscoded

In the analysis of the ICD-10 diagnoses in the period of 2009 to 2019, fracture incidence of 36 traumatic S-codes are listed: lumbar spine fractures are in fifth place, with 47 874 cases; thoracic spine injuries in ninth, with 28 057; and cervical spine fractures in 15th place, with 11 179. In the introduction to the article (1), the authors mention that the number of osteoporotic fractures is continually increasing due to demographic reasons.

However, if a patient suffers a pathological osteoporotic fracture, i.e. a fracture event without adequate trauma, then an M80 diagnosis must be coded. The vertebral fracture is only to be given an S-code as a main diagnosis, with osteoporosis as a secondary diagnosis, if an elderly person with osteoporosis experiences an adequate trauma, for instance as a result of a bicycle accident.

In the period from 1 February, 2006, to 30 September, 2021, the main diagnosis in our department was a pathological osteoporotic fracture (M80.x) a traumatic cervical fracture (S12), thoracic fracture (S22), or lumbar spine fracture (S32), for 399 (9.83%), 812 (20.0%), 2089 (51.47%), or 795 (19.59%) inpatients, respectively. While the percentage distribution of male/female is balanced until the sixth decade of life, the group of patients over 80 years old has a higher proportion of females and a higher incidence of fractures (with increases by a factor of 10 to 30). A significant proportion of all pathological osteoporotic fractures are not hospitalized at all (2).

This results in three essential statements:

• Pathological osteoporotic vertebral fractures are among the ten most common injuries to the skeletal system: they are underdiagnosed.

• There is a high probability of undercoding and miscoding for elderly patients.

• Undercoding of pathological osteoporotic fractures may be the cause or consequence of the lack of awareness of the need to diagnose and treat the underlying osteoporosis disease.