Podiatry Coding & Billing Alert

Coding for the episode of care is about active treatment

ICD-10 affords podiatry coders much more specificity than ICD-9. Take, for example, ICD-9’s “pain in limb” with the much more targeted options in ICD-10 such as “pain in left foot” or “pain in right toe.”

But sometimes, ICD-10 can be confusing or even absurd. Take, for example, ICD-10’s W59.22XD (Struck by turtle, subsequent encounter).

Putting turtles aside, part of the confusion and absurdity arises from ICD-10’s seventh character descriptors, which describe the encounter’s episode of care. The seventh character in an ICD-10 code is an easy part of the code to misunderstand at first glance. It’s important to remember that the seventh character describes the condition’s episode of care, not the patient’s number of visits.

How to Code for Encounters

A – Initial encounter. Use an initial encounter character when giving the patient active treatment for a specific condition. This doesn’t mean it’s the first time you’re treating the patient, and it doesn’t mean that it’s the first time your patient has had this condition or injury. An initial encounter code isn’t limited just to the very first encounter for a new condition. You can use it for multiple encounters as long as the patient continues to receive active treatment for the condition, even over several days.
The crucial element is that the patient is still receiving active treatment for the condition. It’s based upon the active care received for a condition, not how many physicians treated it. In other words, the seventh character doesn’t reset by seeing different physicians.

D – Subsequent encounter. Use the subsequent encounter character after the patient has received active treatment for the condition and you’re now providing routine care for the condition during the healing or recovery phase. If you’re providing follow up care from the injury or condition indicated by the diagnosis, then the subsequent encounter code is the right one.
S – Sequela. You’ll code for a sequela seventh character for conditions or complications that develop as a result of an injury or condition. There’s no time limit.

Remember. It’s important to note that when a code requires a seventh character that you must use an X for all unused characters. If you’re adding a seventh character to a code that contains five or fewer characters, you must enter an “X” in each empty character slot to string them together.

Also, not putting a seventh character on a code that requires one will result in a denial, as would adding one to a code that doesn’t require it.

You’ll find most codes requiring a seventh character in Chapter 19 (Injury, Poisoning and Certain Other Consequences of External Causes) and Chapter 15 (Pregnancy, Childbirth and the Puerperium).

ICD-10 Encounter Coding Case Study

It will likely be rare that you’ll need to report W59.22XXD, but Arnold Beresh, DPM, CPC, CSFAC, of Newport News, VA, shares the following scenario describing a patient struck by turtle as a case study to help you master and remember the nuances of encounter coding.

Read on for the case of Heroes in a Half Shell, Criminal in a Full Cast.

A man in a ski mask robbed a local convenience store last year and was confronted by the Teenage Mutant Ninja Turtles. A struggle took place and Michelangelo administered a roundhouse kick, striking the man in the left ankle, disabling him until police arrived to make an arrest. 

While in custody he complained that his left ankle is hurt on the inside and he couldn’t walk. Arresting officer A. Beresh stated, “They say Michelangelo is the party dude, but this was no party for the suspect.”

The suspect was taken to the local hospital emergency room where the ER doctor examined and diagnosed him with a sprain of the left ankle, deltoid ligament. Code for this as:

S93.422A (Sprain of deltoid ligament of left ankle, initial encounter) and
W59.22XA (Struck by turtle, initial encounter).

The robber was incarcerated after treatment and several days later had continued left ankle and new foot pain with difficulty walking. He was taken back to the correctional facility’s treatment center where a podiatrist again examined and took an x-ray, noting a fracture of the left first metatarsal. The treating physician placed him in a cast for six weeks. Code for this as:

S92.315D (Nondisplaced fracture of first metatarsal bone, left foot, subsequent encounter for fracture with routine healing, subsequent encounter).

Authorities brought him to the hospital facility for follow-up of the fracture and a second x-ray was taken, showing no significant healing with delayed healing. Diagnosis codes for this encounter include:

W59.222D, S92.315G (Nondisplaced fracture of first metatarsal bone, left foot, subsequent encounter for fracture with delayed healing).

The patient was released from jail last week and one year later is still having trouble with left foot ankle instability due to the original injury and poor healing fracture of the first metatarsal. Code for this visit with the following diagnosis codes:

W59.222D, M25.572S (Pain in left ankle and joints of left foot, sequela).