Podiatry Coding & Billing Alert

Be ready to consult three books to correctly code this scenario.

In your podiatry practice, it’s probable that you’ll be coding claims for a variety of fractures, such as those of the metatarsal, calcaneus, and ankle.

The complexity of correctly coding these fractures increases due to all the ICD-10 code options. Not only is it essential to pinpoint the exact location of the fracture in the patient’s foot, but you also need to scrutinize the medical records for specifics like whether the fracture was shifted or stable, if it was open or closed, and if it was the first instance or a follow-up visit.

Enhance your fracture reporting skills by challenging yourself with the following scenario.

Scenario: A new patient came into the podiatrist’s office, complaining of pain in their right foot. The patient mentioned that the injury happened two weeks before when they fell off a step ladder in their home. They went to an orthopedic clinic, and X-rays were taken but no fracture was found. However, their pain continued to persist, so they sought a second opinion with the podiatrist. The podiatrist took anterior to posterior (AP), lateral, and oblique X-ray views of the patient’s foot to assess a possible fracture. The X-rays revealed an enhanced soft tissue density in the right forefoot. However, it did not indicate any fractures, discoloration, degenerative changes, malalignment, or increased radiolucency.

Despite the X-ray not indicating a fracture, the podiatrist detected a potential irregularity during the foot examination. To further assess the proximal shaft of the first metatarsal, the podiatrist used an ultrasound (US) to observe an increased dorsal cortical thickness in the first metatarsal. The podiatrist identified a compression fracture in the patient’s first metatarsal, accompanied by swelling. The fracture did not result in an open wound. The patient was provided with a surgical shoe, which the podiatrist assisted in fitting correctly, and was given instructions for walking with it. The patient is scheduled to return for a checkup in two weeks.

Step 1: Choose the Appropriate ICD-10 Codes

Because ICD-10 does not offer a specific code for a compression fracture, you would look for details in the medical documentation and determine whether the fracture was open or closed, or displaced or nondisplaced, then you would choose the code that best describes the fracture pertaining to the particular bone.

Since the bone did not break the skin, this is a closed fracture. It is also nondisplaced because the podiatrist noticed negative malalignment on the X-ray. So, you should report S92.314A (Nondisplaced fracture of first metatarsal bone, right foot, initial encounter for closed fracture) for the first metatarsal compression fracture.

Compression fracture defined: “A compression fracture is defined as the collapsing of the cortical bone,” explains William Respess, DPM, of Foot & Ankle East in Greenville, North Carolina. “When most people hear the word ‘fracture,’ they think it must be a big crack in the bone, but a fracture is any break in the bone.”

A compression fracture is very difficult to ascertain because it is often dismissed as a contusion, Respess says. For this reason, podiatrists will often use an US or magnetic resonance imaging (MRI) to diagnose a compression fracture.

According to Respess, common treatment options for compression fractures include decreased activity, immobilization, elevation, and wearing a surgical shoe or boot.

Step 2: Choose the Applicable CPT^® Codes

For this patient’s scenario, you will need to report several procedure codes from different sections of the CPT^® book. Let’s review the appropriate codes for this claim below.

Evaluation and management (E/M): For the E/M visit, you should report 99203 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded).

You would choose this code because the patient is new, and the level of medical decision making (MDM) only rises to a low level. That’s because the patient’s compression fracture is an acute, uncomplicated illness or injury, and the risk of morbidity to the patient from additional diagnostic testing or treatment is low.

X-ray: According to the operative report, the podiatrist took three views of the patient’s foot: AP, lateral, and oblique. So, for the X-ray, you should report 73630 (Radiologic examination, foot; complete, minimum of 3 views).