Podiatry Coding & Billing Alert

Differentiate between bruises due to trauma and those due to contusion for correct coding. 

Patients with injuries caused by contusions and bruises on the feet are regular visitorsin a podiatrist’s clinic. Easy bruising is not a diagnosis, but rather a symptom. Therefore, the diagnostic codes depend on whether or not your physician identified a cause. Stay ahead of the game by keeping this ICD-10 conversion kit nearby when you code for contusions starting October 1, 2015.

Background: A bruise, or contusion, is caused when blood vessels are damaged or broken as the result of a blow to the skin of the part of the foot, ankle, or toes (such as an accidental hammer hit). The raised area of a bump or bruise results from blood leaking from these injured blood vessels into the tissues as well as from the body’s response to the injury. Contusions cause swelling and pain, and limit joint range of motion near the injury. In severe cases, swelling and bleeding beneath the skin may cause shock. If tissue damage is extensive, you may also have a broken bone, dislocated joint, sprain, torn muscle, or other injuries.

Currently, if a patient presents with a contusion, you need to answer two questions in order to choose the correct diagnosis code: 

1) Is the skin intact?
2) Where is the contusion?

If the skin is intact, you choose a code in the 924.xx (Contusion of lower limb and of other and unspecified sites) category, which includes bruising and/or hematomas. The fourth and fifth digits, however, are determined the anatomic site. Depending upon the exact location on the foot, you may decide upon 924.20 (Contusion of foot) if the injury is on the heels or 924.21 (Contusion of ankle) for injury on the ankle but without any toe injury.

If the toe is involved, you report 924.3 (Contusion of toe) and 924.5 (Contusion of unspecified part of lower limb) for unspecified lower limb contusions.

Tick Off Multiple Criteria Before Finalizing Code 

Next year onward, you will have to answer the following questions before arriving at the right code:

1) What is the exact site of contusion (ankle, toe or foot)?
2) Is the contusion on the left side?
3) For injuries of ankle, is this the first visit or subsequent?

Foot/ankle: For coding lower limb contusions, especially, foot and ankle, you will have to check under S90 (Superficial injury of ankle, foot and toes) section. For contusion of the ankle, you will choose from S90.0 (Contusion of ankle).The code is further expanded with S90.00-- for unspecified ankle, S90.01-- for right ankle contusion, and S90.02-- for left ankle. If you encounter contusions of the foot, you will have to visit S90.30-- (Contusion of unspecified foot), S90.31-- (Contusion of right foot), and S90.32-- (Contusion of left foot). Notice that there is a further sixth and seventh digit expansion. The expansions XA, XD and XS in both ankle and foot contusions will describe if the encounter was initial, subsequent, or sequela.

Toe: For reporting contusions of the toe, you will have first decide whether there is any injury to the toenails or not. In absence of nail injury, ICD-10 gives you the options of S90.11-- (Contusion of great toe without damage to nail) and S90.12-- (Contusion of lesser toe without damage to nail). In cases of toe contusion with added nail injury, you will be able to report S90.21-- (Contusion of great toe with damage to nail) and S90.22-- (Contusion of lesser toe with damage to nail). There is a sixth digit expansion 1, 2, and 9 in all these codes specifying whether the site is right toe, left toe or unspecified. You will also have to use a seventh digit expansion A, D, or S to indicate the type of encounter- initial or otherwise.

For example, for a soccer player who was seen for the first time by a podiatrist for bruises in the right heel, you currently use 924.20 (Contusion of foot). Note that, per ICD-9, these codes exclude contusions that are incidental to specific categories of injuries, such as crushing injury (925-929.9), dislocation (830.0-839.9), fracture (800.0-829.1),internal injury (860.0-869.1), intracranial injury (850.0-854.1), nerve injury (950.0-957.9), and open wound (870.0-897.7).

Under ICD-10, you will be better able capture the specifics of the diagnosis. You will code S90.31XA for the initial encounter.