Podiatry Coding & Billing Alert

Remember: Don’t forget to report the x-ray code on your claim.

You will most likely have to submit claims for many types of fractures in your podiatry practice, including metatarsal, calcaneal, and ankle fractures. Fractures can be challenging because ICD-10 offers so much specificity. Not only must you know exactly which part of the foot the patient fractured, but you must also check the documentation for details such as if the fracture was displaced or nondisplaced, whether it was open or closed, and whether it was an initial or subsequent encounter

Test yourself with the following scenario to keep your fracture reporting skills sharp.

Scenario:
A new patient came into the podiatrist’s office, complaining of pain in her left foot. The patient mentioned that the injury happened two weeks before. She went to an orthopedic clinic, and they took x-rays, but they did not see a fracture. However, her pain continued to persist, so she sought a second opinion with the podiatrist. The podiatrist took X-rays of the patient’s foot to assess a possible fracture. The podiatrist took AP, Lateral, and Oblique views of the patient’s foot. The x-ray showed positive increased soft tissue density of the left forefoot but showed negative fracture, negative discoloration, negative degenerative changes, negative malalignment, and negative increased radiolucency. The podiatrist performed a detailed exam, a detailed history, and used medical decision making of low complexity during this evaluation and management (E/M) visit. Although the x-ray showed up negative for a fracture, the podiatrist felt a possible abnormality during the exam of the patient’s foot. The podiatrist then used an ultrasound to evaluate the first metatarsal proximal shaft. The podiatrist noticed notable hypoechoic signal intensity with increased cortical dorsal for the first metatarsal with an increased hypoechoic signal. The podiatrist diagnosed the patient with a first metatarsal compression fracture with an edema. The fracture did not break the skin. The podiatrist gave the patient a surgical shoe to wear, helped with the proper fitting, and gave ambulatory instructions for use. The patient will return for a follow-up in two weeks.

Step 1: Choose the Appropriate ICD-10 Codes

ICD-10 does not offer a specific code for a compression fracture, says Arnold Beresh, DPM, CPC, CSFAC, in West Bloomfield, Michigan. So, 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.

In this case, the fracture is closed because it did not break the skin. It is also nondisplaced because the podiatrist noticed negative malalignment on the x-ray. So, you should report S92.315A (Nondisplaced fracture of first metatarsal bone, left foot, initial encounter for closed fracture) for the first metatarsal compression fracture.

Compression fractures 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 has to be a big crack in the bone, but a fracture is actually any break in the bone.”

A compression fracture is very difficult to ascertain because it is often dismissed as a contusion, Respess says. Podiatrists will often use an ultrasound or MRI to diagnose a compression fracture.

Compression fractures most commonly occur in some type of trauma or when there is osteoporosis with loss of bone calcium weakening the bone structure, Beresh adds.

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

Step 2: Remember Your Numerous CPT^® Options

For this scenario, you will need to report several procedure codes from different sections of the CPT^® manual. Take a look at 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 these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity…).

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). Notice this code descriptor specifies that the podiatrist takes at least three views of the patient’s foot.

Ultrasound: For the ultrasound, you should report 76881 (Ultrasound, complete joint (ie, joint space and peri-articular soft-tissue structures), real-time with image documentation).

Orthopedic shoe: For the surgical shoe, you should report L3260 (Surgical boot/shoe, each).

Step 3: And, Put It All Together on Your Claim

In summary, for this encounter, you would report the following codes on your claim:

• S92.315A for the fracture
• 76881 for the ultrasound
• 73630 for the x-ray
• L3260 for the surgical shoe