Two fractures share one treatment

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 heavy object falls on the right foot. Radiographs and the treating physician identify separate closed, nondisplaced shaft fractures of the fourth and fifth metatarsals. Skin, toe sensation and distal perfusion are intact. No dislocation is diagnosed.

Signed treatment note

The physician treats both metatarsal fractures without manipulation and applies one short-leg cast to stabilize the right foot. No reduction, percutaneous fixation or open procedure is performed. The physician documents cast checks, activity instructions and return precautions and assumes subsequent fracture care.

Injury abstraction

The record identifies the fourth-metatarsal fracture and fifth-metatarsal fracture separately. Both receive the same closed treatment in the same cast at this encounter. Their separate identities remain in the clinical abstraction even though they share a procedure-unit rule.

Procedure worksheet

A draft lists two units of the same closed-treatment-without-manipulation procedure solely because there are two fractured metatarsals. Review that count under Medicare NCCI. The exercise concerns these same-foot fractures and this shared treatment, not every possible combination of fractures.

Your coding worksheet

Identify the two injured bones and side.
Identify the treatment actually provided to both fractures.
Correct the two-unit proposal under the Medicare shared-treatment rule.
Explain why preserving both injuries does not require two procedure units.

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 fourth and fifth metatarsal shafts of the right foot have closed, nondisplaced fractures. Preserve both documented injuries.
Both fractures receive closed treatment without manipulation through one cast, with follow-up assumed by the treating physician.
NCCI G.16 and H.9–10 support one unit of the applicable treatment code for these metatarsal fractures sharing this treatment.
Use the full current entry for closed metatarsal treatment without manipulation. Different treatment or another anatomical area would require its own review; do not generalize this example to all fractures.

Reference sections: G.16,H.9–10

Practice the linked chart questions