Orthopedic Coding Alert

Question: A patient reported to our practice complaining of pain in the right ankle region. The ICD-10-CM index has no entry for Pain, foot and instead directed us to Pain, limb, lower, where we found M79.67- (Pain in foot and toes). But, I also saw that there is an index entry for Pain, joint, where I found M25.57- (Pain in ankle and joints of foot). Which code should I report?

Florida Subscriber

Answer: As Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico, explains it, the key to correctly coding this scenario involves “the coder being aware of the basic title of the code category. The arthropathy codes [M00-M25],” Witt goes on, “represent problems with the joints, while the M79 codes represent conditions involving the soft tissue.”

So, whether you code M79.671 or M25.571 in this situation will depend on the exact nature of the patient’s pain.

Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians, notes that you would use M25.57- “along with a sixth digit to specify the foot [1-right, 2-left, 9-unspecified] if the pain is in the ankle or another joint within the foot. If the pain is in the soft tissue of the foot or toes,” Moore goes on, “you would use M79.67- also with a sixth digit to specify laterality and whether the pain is in the foot or toes.”

Coding alert: As both codes are Excludes2 codes for each other, it is entirely possible that you could use both in this situation depending on your provider’s documentation.