Podiatry Coding & Billing Alert

Get ready to query your physician in depth for getting the right diagnosis. 

Fractures of the foot are a common sight in podiatry clinics and you have to stay on your toes to get a grip on the ins and outs of the diagnostic coding. As the ICD-9 system rides into the sunset and the new ICD-10 nomenclature takes over, you will have to tighten up your skills so as not miss on the greater specificities and better accuracy in the new system. Keep these ICD-10 crossover codes near you when you start coding those heelbone fractures from next year.

Noting a Simple Heel Bone Fracture Just Won’t Cut it in Future

Heel bone or calcaneous fractures are mostly caused by high impact injuries such as accidents or falls. When a patient reports to the clinic, the physician orders an X-ray to determine the location of the fracture. If he diagnoses the fracture of the calcaneus, you check whether the fracture is closed or open. You currently refer to the 825 series of ICD-9 for the code especially 825.0 (Fracture of calcaneus closed) or 825.1 (Fracture of calcaneus open).That’s it. In ICD-10, however, you will have to insist on your physician to be a lot more specific in his documentation if you don’t want your claims to rebound on you.

From next year, you will refer to section S92.0 (Fracture of calcaneus) for the same. That’s not all. Get ready to delve deep into your physician’s notes for locking accurately onto the fracture site within the calcaneus as section S92.0 branches extensively into seven choices for the fourth digit (0-6). Subsection S92.00 (Unspecified fracture of calcaneus) refers to unspecified heel bone fractures. ICD-9 code 825.0 cross walks directly to S92.009A (Unspecified fracture of unspecified calcaneus, initial encounter for closed fracture) and 825.1 has been cross-matched with S92.009B (Unspecified fracture of unspecified calcaneus, initial encounter for open fracture) within the S92.00 series.S92.00 further expands into the sixth digit (S92.001, S92.002, and S92.009) that decides if the unspecified fracture is on the right heel bone, the left heel bone, or on an unspecified site, respectively. Lastly, the code will be completed with a seventh digit as explained below.

Other than S92.00, ICD-10 has expanded this section substantively and lays out other diagnostic choices in this section, namely, S92.01 (Fracture of body of calcaneus), S92.02 (Fracture of anterior process of calcaneus), S92.03 (Avulsion fracture of tuberosity of calcaneus), S92.04 (Other fracture of tuberosity of calcaneus), S92.05 (Other extraarticular fracture of calcaneus), and S92.06 (Intraarticular fracture of calcaneus). All these codes (S92.01-06) have a sixth digit expansion (1-6) that determines the side of the body the fracture is located, presence of displacement or absence thereof, and a choice for denoting non-specificity in case the physician is unable to provide anairtight diagnosis. 

For example, in case of an intraarticular fracture of calcaneus (S92.06), you may code S92.061 (Displaced intraarticular fracture of right calcaneus), S92.062 (Displaced intraarticular fracture of left calcaneus), S92.063 (Displaced intraarticular fracture of unspecified calcaneus), S92.064 (Nondisplacedintraarticular fracture of right calcaneus), S92.065 (Nondisplacedintraarticular fracture of left calcaneus), or S92.066 (Nondisplacedintraarticular fracture of unspecified calcaneus) depending on your podiatrist’s diagnosis from next year. And then, you will have to add a seventh digit to complete the code. 

7th Digit Expansion Signifies Progress of Healing 

For reporting of fractures, ICD-10 has added some new dimensions to capture the type of encounter (initial or subsequent), type of fracture (open or closed), and progress of healing (delayed, malunion, or non-union) over subsequent visits of the patient to the clinic. For this purpose, the seventh digit in the fracture codes has been assigned to capture this fact. So, the seventh digit will display as:

• A -- initial encounter for closed fracture
  
• B -- initial encounter for open fracture
  
• D -- subsequent encounter for fracture with routine healing
  
• G -- subsequent encounter for fracture with delayed healing
  
• K -- subsequent encounter for fracture with nonunion
  
• P -- subsequent encounter for fracture with malunion
  
• S -- sequela
  

For instance, if your physician diagnoses a patient with an unspecified closed fracture of the right heel bone in first visit to the clinic, you will have to report the encounter with S92.001A (Unspecified fracture of right calcaneus, initial encounter for closed fracture). If the same patient comes again to the clinic during the treatment, you may report the visit as S92.001D (Unspecified fracture of right calcaneus, subsequent encounter for fracture with routine healing) if he is healing normally.

Coding Scenario: A patient reports to your podiatrist after a fall and the physician confirms a calcaneal fracture. The physician performs plantar displacement of the forefoot and hindfoot to reduce the fracture and then applies a short cast to stabilize the fracture. 

Currently, you will report code 28405 (Closed treatment of calcaneal fracture; with manipulation) for this service and link it with diagnosis code 825.0. However, in ICD-10, you will have to check the documentation for the finer details of the fracture to accurately report the encounter. You may have to cajole and query the physician to be much more specific. So, if you find out that the fracture was in the front and to the outside of the ankle on the right foot with reported displacement and this was the patient’s first visit, you will back up code 28405 with diagnosis code S92.021A.