Aftercare, Musculoskeletal System and Connective Tissue Diagnosis Related Groups (DRGs)

Published 11/29/2021

DRG 559 — Aftercare, Musculoskeletal System and Connective Tissue with Major Complication or Comorbidity (MCC)

DRG 560 — Aftercare, Musculoskeletal System and Connective Tissue with Complication or Comorbidity (CC)

DRG 561 — Aftercare, Musculoskeletal System and Connective Tissue without CC/MCC

Principal Diagnosis Tips

M48.4 — Fatigue fracture of vertebra: Also called a stress fracture because the cause is from repetitive stress or trivial repeated trauma to an area. This code should not be used for acute traumatic fracture.

M80. — Age-related osteoporosis with current pathological fracture: Osteoporosis is a medical condition in which the bones become brittle and fragile from loss of tissue. This is typically a result of hormonal changes, or deficiency of calcium or vitamin D. Osteoporosis often presents with osteopenia which is lower bone density than normal. Osteopenia is reported with codes in subcategory M85.8.

M84.4 — Pathological fracture: A pathologic fracture is a break in a bone that is caused by an underlying disease. These are often differentiated from traumatic fractures by clinically assessing the magnitude of the trauma or stress causing the fracture. A relatively minor trauma or stress can cause a pathological fracture is bones diseased by metabolic bone disease, disseminated bone disorders, inflammatory bone diseases, Paget’s disease, or neoplasms. These are also referred to as chronic fractures.

S-Fracture codes — The Gustilo classification, is used for the reporting of open (or compound) fractures of the forearm, femur, and lower leg (to include the ankle). The grading system is used to guide management of compound fractures, with higher grade injuries associated with higher risk of complications. Soft tissue injury is graded on a combination of:

  • Amount of energy dissipated
  • Extent of soft-tissue injury
  • Degree of contamination

Gustilo Classification

  • Grade 1: clean wound <1 cm in length
  • Grade 2: wound 1-10 cm in length without extensive soft-tissue damage, flaps, or avulsions
  • Grade 3: extensive soft-tissue laceration (>10 cm) or tissue loss/damage or an open segmental fracture
    • Open fractures caused by farm injuries
    • Injuries requiring vascular intervention
    • Fractures that have been open for eight (8) hours prior to treatment

Grade 3 injuries can be further subdivided by the degree of periosteal and vascular injury and soft tissue loss:

  • Grade 3a — Adequate periosteal coverage of the fracture bone despite the extensive soft-tissue laceration or damage
  • Grade 3b
    • Extensive soft-tissue loss, periosteal stripping, and bone damage
    • Usually associated with massive contamination
    • Will often need further soft-tissue coverage procedure (e.g. Free or rotational flap)
  • Grade 3c — Associated with an arterial injury requiring repair, irrespective of degree of soft-tissue injury

Consider These Potential DRGs

  • DRG 495-497 — Local Excision and Removal of Internal Fixation Devices except Hip and Femur
    • Complications of internal orthopedic device (mechanical, infection, other)
    • Encounter for removal of internal fixation device
    • Removal of implanted device except for femur
  • DRG  498-499 — Local Excision and Removal Internal Fixation Devices of Hip and Femur
    • Complications of internal orthopedic device (mechanical, infection, other)
    • Encounter for removal of internal fixation device
    • Removal of implanted device except from the femur