# New coder needs help



## nicoabaj (Dec 29, 2010)

I am looking for the ICD 9 code for "idiopathic" toe walking. The orders show no indication of any other diagnosis. Would I just use Abnormality of gait?


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## btadlock1 (Dec 29, 2010)

That looks like the right choice to me.


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## preserene (Dec 29, 2010)

"Idiopathic Toe-walking"

This is also called habitual toe walking, hereditary tendo Achilles contracture,or *congenital short tendo calcaneous.* 70% of them have positive family history.
Though it develops eventually to a heel-toe gait, it is not a classical gait abnormality or deformity, it is hard for us to accept, though. Variable amount of contracture and restriction of ankle flexion are noted. No muscle weakness no changes in tendon reflexes.
*It is the diagnosis of exclusion*. All conditions that may be associated with an equine deformity and contracture of the tendoAchilles must be ruled out to diagnose IDIOPATHIC TOE WALKING.
The typical patient with ‘idiopathic toe walking' HAS NO ABNORMAL FINDINGS OTHER THAN THOSE REFERABLE TO THE EQUINUS DEFORMITY WITH VARYING DEGREE OF CONTRACTURE OF THE TENDO-ACHILLES TENDON..They have normal sensation,no pain, and no muscle dysfunction.
Having these in mind can we figure out some nearer code assignment:
*756.89* - Other congenital musculocutaneous anomalies; Other- congenital shortening of tendon
How about 754.8 congenital generalized flextion contractures of lower limb joints(but not happy with the term generalized). 
Hope we do better with this.


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## btadlock1 (Dec 29, 2010)

"Idiopathic" means arising suddenly, with no known cause. I wouldn't assign a congenital cause to something that has been specified as idiopathic. If the doctor had meant to say "toe walking due to shortened tendon", then he would have. The fact that he used the term "idiopathic" signifies that he doesn't know what the cause is.


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## preserene (Dec 29, 2010)

Idiopathic is not SUDDEN. It is without proper reason or cause-ie unknown etiology.
DO NOT QUESTION my statement  with the your 'known or assumed facts'
.
IT IS A SEPARATE ,HUGE TOPIC/ENTITY/CONDITION BY ITSELF AS "  IDIOPATHIC TOEWALKING" AND IS AN ONGOING TOPIC IN MEDICAL  FORUM AND MEDICAL WORLD OF SPECIALIST now and then.
 so do not question or doubt when it is a fact. if you want to clarify with physician specially ortho, please do that when you find time and get to know please.


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## btadlock1 (Dec 29, 2010)

preserene said:


> Idiopathic is not SUDDEN. It is without proper reason or cause-ie unknown etiology.
> DO NOT QUESTION my statement  with the your 'known or assumed facts'
> .
> IT IS A SEPARATE ,HUGE TOPIC/ENTITY/CONDITION BY ITSELF AS "  IDIOPATHIC TOEWALKING" AND IS AN ONGOING TOPIC IN MEDICAL  FORUM AND MEDICAL WORLD OF SPECIALIST now and then.
> so do not question or doubt when it is a fact. if you want to clarify with physician specially ortho, please do that when you find time and get to know please.



We've been over this before - I don't make stuff up and pass it off as "expertise" - I wouldn't dare take that away from you. I did, however, use the word "suddenly", when the correct word is "spontaneously". I apologize for that mistake.

Per Wikipedia (http://en.wikipedia.org/wiki/Idiopathic):
"Idiopathic is an adjective used primarily in medicine meaning arising spontaneously or from an obscure or unknown cause. From Greek ἴδιος, idios (one's own) + πάθος, pathos (suffering), it means approximately "a disease of its own kind". It is technically a term from nosology, the classification of disease. For some medical conditions, one or more causes are somewhat understood, but in a certain percentage of people with the condition, the cause may not be readily apparent or characterized. In these cases, the origin of the condition is said to be idiopathic.

With some medical conditions, the medical community cannot establish a root cause for a large percentage of all cases (for example, focal segmental glomerulosclerosis, the majority of which are idiopathic);[1] with other conditions, however, idiopathic cases account for a small percentage (for example, pulmonary fibrosis).[2] As medical and scientific advances are made with relation to a particular condition or disease, more root causes are discovered, and the percentage of cases designated as idiopathic shrinks."


You are correct that *one cause *of toe walking is a shortened tendon; but that is only one cause. No, I don't have time to find an ortho doc to lecture me on the issue, so I hope the National Institutes of Health are reputable enough to satisfy you. According to them:

"Idiopathic toe-walking is a diagnosis of exclusion when a child presents with bilateral toe-to-toe gait. Although toe-walking is considered part of the normal gait spectrum in development, it is abnormal when persisting past the age of two. Toe-walking may be caused by cerebral palsy, congenital contracture of the Achilles tendon or paralytic muscular disorders such as Duchenne Muscular Dystrophy. Idiopathic toe-walking may be associated with developmental disorders such as autism or other myopathic or neuropathic disorders. The majority of disorders causing toe-walking can be ruled out through the history and physical examination, resulting in a diagnosis of idiopathic toe-walking. However, it may be difficult to differentiate mild forms of cerebral palsy, specifically mild spastic diplegia, and idiopathic toe-walking. The treatment options for idiopathic toe-walking include observation, conservative methods and surgical methods. Most children can be treated in the primary care setting with either observation or conservative treatment. Patients with severe contracture of the Achilles tendon, or persistent toe-walking, may need surgical intervention. The prognosis of idiopathic toe-walking is favorable with both conservative and surgical treatment allowing children to attain normal function and range of plantarflexion. The following article provides an overview of the background information, differential diagnosis and treatment options for idiopathic toe-walking."

http://www.ncbi.nlm.nih.gov/pubmed/18432151


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## ohn0disaster (Dec 29, 2010)

Do not question my statement with your known or assumed facts??!?!?? YOU HAVE GOT TO BE KIDDING ME!! You're kidding, RIGHT? I am at the point of complaining to the AAPC about your use of these forums, preserene. You are constantly answering threads with misleading information and assumption coding. Then you claim that you are an expert and that all others are wrong. This is getting ridiculous. You have absolutely NO COUTH and no respect for others.


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## preserene (Dec 29, 2010)

btadlock1 said:


> We've been over this before - I don't make stuff up and pass it off as "expertise" - I wouldn't dare take that away from you. I did, however, use the word "suddenly", when the correct word is "spontaneously". I apologize for that mistake.
> 
> Per Wikipedia (http://en.wikipedia.org/wiki/Idiopathic):
> "Idiopathic is an adjective used primarily in medicine meaning arising spontaneously or from an obscure or unknown cause. From Greek ἴδιος, idios (one's own) + πάθος, pathos (suffering), it means approximately "a disease of its own kind". It is technically a term from nosology, the classification of disease. For some medical conditions, one or more causes are somewhat understood, but in a certain percentage of people with the condition, the cause may not be readily apparent or characterized. In these cases, the origin of the condition is said to be idiopathic.
> ...



Brandi, that is what I gave in brief. All these narrated about idiopathic is congenital in origin or familial or inherited. I gave earlier 70% of them are congenital. the contracture about tendo achillis is a manifestation in idiopathic toewalking. We are only dealing with idiopathic and in a word I said these idiopathic are congenital.
What is that is wrong in my post?


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## btadlock1 (Dec 29, 2010)

preserene said:


> Brandi, that is what I gave in brief. All these narrated about idiopathic is congenital in origin or familial or inherited. I gave earlier 70% of them are congenital. the contracture about tendo achillis is a manifestation in idiopathic toewalking. We are only dealing with idiopathic and in a word I said these idiopathic are congenital.
> What is that is wrong in my post?



What's wrong with it is that you've definitively assigned an etiology to it that hasn't been established by the rendering physician. The post didn't say that the achilles tendon was the suspected cause, or that anything else had been ruled out. All we were given to go on is "idiopathic toe walking". Regardless of the fact that 70% of cases are linked to a congenitally short tendon, it's not safe to assume that this particular case is in the majority, for the sake of specificity. That statistic means that 30% (or nearly 1/3) of cases are *not* associated with the congenital anomoly; and, as the article I quoted mentions, it can be difficult to differentiate between some of the other causes and the one that you have chosen. The highest level of specificity *allowed* for coding purposes is not based on anecdotal evidence, no matter how compelling. It's based off of what the physician has recorded in the documentation. Everything else is pure conjecture; including assumptions made without seeing the body of the note. In the absence of more detailed information, the correct code to describe "idiopathic toe walking" on its own, is the generic assignment of 781.2.


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## mitchellde (Dec 29, 2010)

I agree with Brandi, we cannot assume a condition is congenital which is what you have suggested we are NOT the physician for this patient and therefore connot make any assumptions regarding a diagnostic statement.  If it does not specify congenital then we cannot assume that it is.  You really must refrain from making assumptions.  Also the disresrectful tone of some of the posts is very disheartening.  We have a hard enough time becoming recognized as respected professionals in this industry, must we bicker so amongst ourselves??  It only takes away from us each time this occurs.


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## kjohnson (Dec 30, 2010)

I use this forum quite often and get lots of good information from it. I have to admit I was quite shocked with Preserene's above statement to Brandi. I think it is in terrible taste to talk like that and quite frankly puts a big black mark on any credibility that preserene might think they have. I think an apology is in order. There was no professionalism in the way that comment was made and I don't believe there is any place for that on this forum.


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