Podiatry Coding & Billing Alert

Remember to add an external cause code to your claim.

From slight fissures to clean breaks, foot fractures are some of the most common injuries diagnosed and treated by podiatrists. But even though the injuries are common, coding them can be confusing. That’s why we came up with this case study, so you could brush up on your simple fracture care coding.

The case: An 80-year-old patient reports to the podiatric office. The established patient was walking outside at home and slipped on some ice. They are now complaining of severe pain in their left foot, specifically in the area of their small toe. The patient has no known allergies and no significant past medical history.

Upon physical examination, the podiatrist noted swelling and tenderness over the left small toe. The patient was unable to move their toe without experiencing pain. The podiatrist suspected a possible fracture and ordered an X-ray, which confirmed a small fracture that did not need manipulation. The podiatrist then buddy taped the fractured toe to the adjacent toe to immobilize it and prescribed over-the-counter pain medication. The patient was advised to rest and avoid putting weight on the foot as much as possible. The practitioner scheduled a follow-up appointment in one week to monitor the healing process.

Navigate the Toe Fracture Treatment Codes

If you’re unfamiliar with these codes, using them can seem a bit overwhelming. You’ll likely first come across the following when looking for one that best matches the treatment in the case study.

• 28490 (Closed treatment of fracture great toe, phalanx or phalanges; without manipulation)
• 28495 (… with manipulation)
• 28510 (Closed treatment of fracture, phalanx or phalanges, other than great toe; without manipulation, each)
• 28515 (… with manipulation, each)

If you look at the descriptors carefully, you’ll see several things that the codes have in common. The first is that they all describe closed treatments of the fracture. This means the fracture is treated without any surgical incision. This generally means realigning the bone through manipulation or some kind of split.

Note: You’ll also come across codes that describe “open” treatment, which refers to the fracture site itself being open to the external environment, not that the physician opened the site. This type of injury is rare even in an emergency room setting and is most likely too severe an injury for a patient to come to a private practice or clinic.

Fracture care codes are also subdivided into “manipulation” or “without manipulation,” notes Samuel “Le” Church, MD, MPH, CPC, CRC, FAAFP, core faculty family medicine residency at Northeast Georgia Health System. Fracture manipulation (or fracture reduction) is a procedure that’s used to align broken bones that are angulated, displaced, or dislocated to promote proper healing. The physician uses their hands or specific tools to adjust the pieces of the fracture into their normal position.

However, in the case study, the podiatrist did not manipulate the bones. So, which code should you report?

Don’t Jump to Fracture Care Codes if an E/M Code Will Do

If you quickly consider a fracture care code like 28515, it could lead to a denial if the bone manipulation wasn’t performed. According to Jennifer McNamara, CPC, CCS, CRC, CPMA, CDEO, COSC, CGSC, COPC, director of healthcare training and practice support at Healthcare Inspired LLC, in Bella Vista, Arkansas, “In such cases, code 28510, indicating treatment without manipulation, may be more appropriate.”

Alternately, you might choose to bill for an evaluation and management (E/M) code alongside code 29550 (Strapping; toes). Buddy taping, or toe strapping, involves taping the injured toe to an adjacent one for support and immobilization, aiding healing. This nonoperative treatment falls under 28510 and can be itemized with an E/M and treatment code. “Many providers opt for itemizing in such cases, considering the unlikelihood of the patient requiring up to 90 days of treatment encompassed in the global package for 28510,” says McNamara.

Coding alert: In cases where the injury is severe enough to require manipulation and significant care in addition to the strapping, you would not report 29550, as it is bundled with the initial fracture care code.

Parse Out Important Details for ICD-10 Coding

Now that you understand which service codes to provide, consider the details of the notes. There is a lot of information to go through, but the first thing to do is determine everything that’s important for proper coding.

You’re dealing with an injury, which means you’ll report an S code. These codes provide information about the cause, location, and type of injury. Therefore, for coding this encounter, you would need the following information: