Podiatry Coding & Billing Alert

Examine the symptoms to crack the code on these tricky foot ailments.

Patients visiting a podiatrist with foot pain may have various underlying conditions that are yet to be diagnosed. Those conditions may present similar symptoms but require very different diagnoses based on their specific manifestations. Coding conditions that share common symptoms like stiffness, pain, and inflammation can be a real head-scratcher.

Below, we’ll explore a few conditions that can be easily mistaken for Freiberg’s disease, a rare condition that affects the metatarsal bones in the foot. And we’ll show you what to look for in your podiatrist’s notes to help you document the right ICD-10 code.

Understanding Freiberg’s Disease

Freiberg’s disease is a condition that affects the metatarsal bones, specifically the second or third metatarsal head, causing pain and stiffness. It is sometimes called Freiberg infraction and is coded to M92.7- (Juvenile osteochondrosis of metatarsus). Symptoms the patient may present with include stiffness, swelling, limited range of motion and discomfort while walking or applying pressure to the foot. Diagnosis is made through a combination of patient history, examination, and imaging such as X-rays or computed tomography (CT) scans of the foot.

To code Freiberg’s disease correctly, you would go to your ICD-10 index and look for “Freiberg” which leads you to an entry directing you to — Osteochondrosis, juvenile, metatarsus, which is coded to M92.7-. In the tabular list, you will notice a few codes to choose from:

• M92.70 (Juvenile osteochondrosis of metatarsus, unspecified foot)
• M92.71 (…right foot)
• M92.72 (…left foot)

You must code to the 5th character to avoid a claim denial.

See the Difference Between Metatarsalgia and Freiberg’s Disease

Metatarsalgia is a condition that causes pain and inflammation in the ball of the foot, which can be confused with Freiberg’s disease. When a patient has metatarsalgia, the ball of their foot becomes painful and inflamed. Metatarsalgia may result in pain, tenderness, and swelling.

Some causes of this condition are obesity, poorly fitting shoes, or intense training/ activity. ICD-10 codes for metatarsalgia are:

• M77.40 (Metatarsalgia, unspecified foot)
• M77.41 (… right foot)
• M77.42 (… left foot)

Similarly in the case of Freiberg’s disease, to diagnose metatarsalgia, podiatrists look at the patient’s history of pain, conduct a physical exam to check for a deformity on the ball of the foot, and use X-rays, magnetic resonance imaging (MRI), and ultrasounds (US). Treatment options for this condition include medication; lifestyle modifications; orthosis or strapping to provide support and reduce stress; physical exercise to improve the range of motion, flexibility, and strength of the muscles; or surgery.

What to look for in the documentation: As Freiberg’s disease affects the second or third metatarsus and is typically seen in children and adolescents, while metatarsalgia can involve any of the metatarsal bones and can affect people of any age, your coding choice should reflect this.

Don’t Stress About Stress Fractures vs. Freiberg’s Infraction

Stress fractures are tiny cracks in the bone caused by repetitive stress or force, often from overuse. These often occur in normal or metabolically weakened bones. Patients may have a stress fracture without even realizing it. When a patient has a stress fracture, they usually complain of pain that is nagging or gradually building.

If you look under M84.3- (Stress fracture) in the ICD-10 manual, you will see that fatigue fractures, March fractures, stress fractures NOS, and stress reactions are all included conditions for this code. When diagnosing a stress fracture, the most common scenario is an office evaluation and management (E/M) service and an X-ray. The podiatrist will ask the patient for their history, including their occupation work and recreational activities as well as conduct a physical exam.

Treatment options for stress fractures can include lifestyle modification, rest, a splint or cast for immobilization, special shoes that support the arch and ankles, and nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain.

Your ICD-10 codes to choose from regarding stress fractures in the toes are as follows: