Reduction and the first cast

Read an original fictional chart, identify the supported facts, and explain your coding workflow.

Chart gym · Original fictional record

Service date: 2026-09-09 · Medicare musculoskeletal professional service

Use your code books and write your reasoning before opening the walkthrough. This exercise contains no real patient information.

Injury assessment

Synthetic record, September 9, 2026. An adult presents after a fall onto an outstretched left hand. Imaging and the treating physician document a traumatic displaced extra-articular fracture of the distal left radius, with no associated ulnar fracture. The skin is intact and the fracture is documented as closed. Finger perfusion and sensation are intact.

Signed treatment note

The physician performs closed reduction with manipulation and confirms improved alignment on post-reduction imaging. A short-arm cast stabilizes the treated fracture. Finger perfusion and sensation remain intact afterward. The physician gives return precautions and assumes subsequent fracture care.

Procedure worksheet

The proposed professional procedure list contains fracture treatment with manipulation and a separate initial cast-application procedure at the same site. Supplies are listed for their own review. No open reduction is documented, and there is no second injury requiring another cast.

Diagnosis worksheet

This encounter provides active treatment of the closed traumatic fracture. Abstract site, side, fracture detail and treatment phase from the record, then confirm the diagnosis in the current Index and Tabular List. The scored question concerns initial-cast inclusion; the book exercise also asks for the treatment family with manipulation.

Your coding worksheet

Identify the supported injury, side and treatment phase.
Identify the completed treatment and manipulation.
Evaluate the separate initial-cast application proposal.
Find the complete diagnosis and treatment entries in the authorized references.

In your notebook, record the supported facts, your index route, the instructions you checked, and any missing detail that limits your answer.

Compare with the worked explanation

The record describes a closed displaced extra-articular distal left-radius fracture receiving active treatment. Confirm the diagnosis entry and required character in the Tabular List.
The procedure is documented closed treatment with manipulation; injury classification and procedure technique remain separate.
Under NCCI the first cast application is included in that same-site fracture treatment.
Use the documented site and technique for the current treatment lookup. Check any separately permitted supplies through their own instructions rather than assuming the application is separate.

Reference sections: G.5–7; ICD-10-CM I.C.19.c

Practice the linked chart questions