An 89-year-old female patient who was admitted to the hospital for cardiac workup became hypotensive and unresponsive following a cardiac catheterization procedure. The patient’s pulse was nonpalpable and cardiopulmonary resuscitation (CPR) was initiated. Subsequently, the patient suffered several fractured ribs secondary to the chest compressions. Per the Official Guidelines for Coding and Reporting and advice previously published in Coding Clinic, Second Quarter 2019, page 24, traumatic injury codes should not be assigned for injuries that occur during, or as a result of, a medical intervention. How should a rib fracture, occurring due to CPR be captured since a traumatic fracture code cannot be assigned?
Assign code M96.89, Other intraoperative and postprocedural complications and disorders of the musculoskeletal system, to capture the rib fractures due to CPR. Code Y84.8, Other medical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure, should be assigned to describe the external cause of the injury.
Fractures of the rib are a known risk and are not uncommon, following closed chest compression. Elderly patients and persons with pre-existing medical conditions, such as osteoporosis, have an increased risk for this type of injury.