Dermatology Coding Alert

New diagnosis codes will distinguish which foot and what type of wound it suffered.

Dermatology coders who were looking for more specificity in reporting open wounds of the ankle and foot have just a few months to wait. Under the ICD-10 diagnosis coding system, effective Oct. 1, 2015, you will pick a code based not only on whether the wound is complicated or has tendon involvement, but also based on which foot is involved, and what type of wound it is.

Open Wound of Ankle

ICD-9 groups open wounds of the knee, lower leg, and ankle together:

• 891.0 — Open wound of knee, leg (except thigh), and ankle without complication

• 891.1 — … complicated

• 891.2 — … with tendon involvement.

ICD-10 gives open wounds of the ankle its own series of codes (the knee and lower leg also get their own series), with specific codes for right and left ankle and type of wound (laceration, puncture, open bite).

7th character: At the end of the six-character ICD-10 codes below, you will add a character describing whether it is an initial encounter (A), subsequent encounter (D), or sequela (S), notes Pamela Biffle, CPC, CPC-P, CPC-I, CPCO, owner of PB Healthcare Consulting and Education Inc. in Austin, Texas. Example: An initial counter for a puncture wound with foreign body of the left foot would be coded S91.342A.

For open wounds of the ankle without tendon involvement, the ICD-10 codes are:

• S91.001x — Unspecified open wound, right ankle

• S91.002x —... left ankle

• S91.009x —... unspecified ankle

• S91.011x — Laceration without foreign body, right ankle

• S91.012x —... left ankle

• S91.019x —... unspecified ankle

• S91.021x — Laceration with foreign body, right ankle

• S91.022x — … left ankle

• S91.029x — … unspecified ankle

• S91.031x — Puncture wound without foreign body, right ankle

• S91.032x —... left ankle

• S91.039x —... unspecified ankle

• S91.041x — Puncture wound with foreign body, right ankle

• S91.042x —... left ankle

• S91.049x —... unspecified ankle 

• S91.051x — Open bite, right ankle

• S91.052x —... left ankle

• S91.059x —... unspecified ankle.

Note: Wounds of muscles and tendons will have their own series of ICD-10 codes (S92-), which will specify which specific muscles are injured.

Open Wound of Foot

ICD-9 offers three codes for open wounds of the foot:

• 892.0 — Open wound of foot except toe(s) alone without complication

• 892.1 — ... complicated

• 892.2 — ... with tendon involvement. 

ICD-10 gets much more specific. Open wounds of the foot with tendon and muscle involvement will also be included in the S92- series. Open foot wounds without tendon involvement will be reported with:

• S91.301x — Unspecified open wound, right foot

• S91.302x — … left foot, initial encounter

• S91.309x — … unspecified foot

• S91.311x — Laceration without foreign body, right foot

• S91.312x — … left foot

• S91.319x — … unspecified foot

• S91.321x — Laceration with foreign body, right foot

• S91.322x — … left foot

• S91.329x — … unspecified foot

• S91.331x — Puncture wound without foreign body, right foot

• S91.332x — … left foot

• S91.339x — … unspecified foot, initial encounter

• S91.341x — Puncture wound with foreign body, right foot

• S91.342x — … left foot

• S91.349x — … unspecified foot

• S91.351x — Open bite, right foot

• S91.352x — … left foot

• S91.359x —… unspecified foot.

Toe wounds: ICD-10 codes describing wounds of the toes will be even more complex and detailed, with specific codes describing not only right or left foot, but great or lesser toe. Look for a discussion of open wound coding in other anatomical sites in a future issue of Dermatology Coding Alert.

Learn more: For more information on the ICD-10 conversion, as well as specific ICD-9 to ICD-10 code bridges, visit https://www.aapc.com/codes/.