ICD 10 Coding Alert

Tip: Focus on the nail to make an accurate choice.

Test your knowledge on the multitude of codes for open wound of the toe by looking at the questions below. Remember that damage to toenail and associated infections are distinguishing factors in relevant codes.

Look to Wound Details and Location

Question 1: What are some questions to ask when reporting ICD-10 codes for open wounds of the toe?

Answer 1: When you report for open wounds of the toe, you should ask yourself the following questions:

• Was there damage to the nail?
• Was the wounded toe a greater or lesser toe?
• Which foot was the wounded toe on?
• What caused the wound: a laceration, puncture or bite?
• If it was a laceration or puncture, is there a foreign body?

Choose These Codes for Great Toe sans Nail Damage

Question 2: How should you report lacerations of the great toe without nail damage?

Answer 2: For a laceration of the great toe without nail damage, without a foreign body, you would look to the following codes:

• S91.111- (Laceration without foreign body of right great toe without damage to nail)
• S91.112- (Laceration without foreign body of left great toe without damage to nail)
• S91.113- (Laceration without foreign body of unspecified great toe without damage to nail).

On the other hand, if the podiatrist does document a foreign body, then you would look to these codes:

• S91.121- (Laceration with foreign body of right great toe without damage to nail)
• S91.122- (Laceration with foreign body of left great toe without damage to nail)
• S91.123- (Laceration with foreign body of unspecified great toe without damage to nail).

Example: A patient came in with a laceration on his right great toe that he sustained with an axe while chopping wood in his backyard. There was no damage to his nail. This was an initial encounter You would report S91.111A (Laceration without foreign body of right great toe without damage to nail, initial encounter) for the diagnosis and W27.0XXA (Contact with workbench tool, initial encounter) for the external cause code.

Don’t miss: Other tools included under code W27.0- are an auger, chisel, handsaw, and screwdriver.

Rely on These Dx Codes for Puncture Wounds of Lesser Toes

Question 3: How should you report puncture wounds of the lesser toes without nail damage?

Answer 3: If the patient has a puncture wound of the lesser toes without a foreign body present, then you would report one of these codes:

• S91.134 (Puncture wound without foreign body of right lesser toe(s) without damage to nail)
• S91.135 (Puncture wound without foreign body of left lesser toe(s) without damage to nail)
• S91.136 (Puncture wound without foreign body of unspecified lesser toe(s) without damage to nail).

On the other hand, if the podiatrist does document a foreign body, then you can look to these codes:

• S91.144 (Puncture wound with foreign body of right lesser toe(s) without damage to nail)
• S91.145 (Puncture wound with foreign body of left lesser toe(s) without damage to nail)
• S91.146 (Puncture wound with foreign body of unspecified lesser toe(s) without damage to nail).

Example: A patient came in with a wound she sustained while gardening. She punctured her left lesser toe with a pitchfork. This was an initial encounter, and there was no damage to her nail. The podiatrist does document a foreign body. You should report S91.145A (Puncture wound with foreign body of left lesser toe(s) without damage to nail, initial encounter).

Utilize These Codes for Open Bites

Question 4: A patient came in with an open bite on his left great toe with nail damage. He received the wound from a squirrel while on a picnic. This was an initial encounter. You would report S91.252A (Open bite of left great toe with damage to nail, initial encounter) as the diagnosis and W53.21XA (Bitten by squirrel, initial encounter) as the external cause code.

Don’t miss: If the patient had sustained an open bite on his right great toe with damage to the nail, you would have reported S91.251- (Open bite of right great toe with damage to nail). If the wounded toe was unspecified in the documentation, you would then report S91.253A (Open bite of unspecified great toe with damage to nail).

Remember the Necessity of the Seventh Character

Question 5: How many characters are in the open wounds for toes codes?

Don’t miss: In addition to the six characters in these open wound codes, you’ll also add a seventh character depending on whether it is an initial encounter (e.g., S91.111A), a subsequent encounter (e.g., S91.111D), or sequela (e.g., S91.111S).

Don’t Forget to Check Coding Notes

Question 6: Are there any coding notes for category S91- (Open wound of ankle, foot and toes)?

Answer 6: Yes. There is a note for category S91- that tells you to “code also any associated wound infection.”

You should always make sure that you code for any infection of the wound, reiterates Arnold Beresh, DPM, CPC, CSFAC,  in West Bloomfield, Michigan.

Coding example: Take a look at this scenario from Beresh: A patient presents to the office stating that she is diabetic and dropped a dirty kitchen knife on her right lesser toe, cutting the top of her toe two days ago. Her toe is now swollen, red, and painful and has a yellow discharge from it. The patient did not sustain damage to her toenail, and there was no foreign body in the wound.

The podiatrist takes a culture of the laceration, and the result from the lab comes back as a staph infection.

ICD-10: You should report S91.114A (Laceration without foreign body of right lesser toe(s) without damage to nail, initial encounter) for the laceration along with the proper ICD-10 code such as B95.8 (Unspecified staphylococcus as the cause of diseases classified elsewhere) for the staph infection. You should also report W26.0XXA (Contact with knife, initial encounter) as the external cause code.