Explain the 'code first' concept with an example.

• A. Code the fracture first
• B. Code only the fracture
• C. For a fracture caused by underlying disease, code the underlying disease first when indicated, with the fracture coded as a subsequent condition
• D. Code only the underlying disease

Answer: (C)

When a fracture happens because of an underlying disease, the underlying disease drives the presentation, so you code that disease first and then record the fracture as a subsequent condition. This ordering shows that the fracture is a consequence of the disease, not an isolated event. For example, if osteoporosis causes a pathologic fracture, code the osteoporosis first and then code the fracture second. Sometimes a single code might exist that already captures both the disease and the fracture, but when the documentation indicates the fracture is caused by the underlying condition, you apply the principle of listing the underlying disease first and the fracture as a secondary condition. This approach preserves the relationship between the root cause and the injury.