Podiatry Coding & Billing Alert

Remember to pay attention to those 7th characters.

Patients with fractures of the foot and ankle are commonplace in your podiatrist’s office. And so, too, are the myths surrounding the diagnosis codes you use to document the encounters.

That’s why we assembled three of the most common fracture coding myths and busted them, so you can code the different kinds of fractures, and the encounters involved in facture care, with precision and ease.

Myth 1: Fractures of the Foot and Ankle Are Always Reported as Injury Codes

This myth is easily busted with a very basic understanding of how fractures occur and how that relates to the ICD-10-CM taxonomy.

The American Academy of Orthopedic Surgeons identifies 3 common causes of bone fractures:

• “Trauma. A fall, motor vehicle accident, or tackle during a football game can all result in fractures.
• “Osteoporosis. This disorder weakens bones and makes them more likely to break.
• “Overuse. Repetitive motion can tire muscles and place more force on bone. This can result in stress fractures. Stress fractures are more common in athletes” (https:// orthoinfo.aaos.org/en/diseases--conditions/fractures-broken-bones/).

Simply put, you’ll only use an injury code from S82- (Fracture of lower leg, including ankle) or S92- (Fracture of foot and toe, except ankle) when reporting a fracture caused by trauma.

Fractures caused by osteoporosis or other diseases such as cancer are known as pathological fractures, meaning that the disease has weakened the bone to the point where it breaks. When your podiatrist documents this kind of fracture, you’ll look to the M80-M85 (Disorders of bone density and structure) codes. You’ll locate the correct code by first identifying the condition causing the fracture, then adding additional characters as appropriate.

Last, overuse fractures — also known as stress, fatigue, or march fractures — are relatively easy to code as they have their own separate subcategory within M80-M85: M84.3- (Stress fracture).

Test yourself: Your podiatrist sees a patient with a pathological fracture of bones in the right foot caused by bone cancer. You’ll report M84.574- (Pathological fracture in neoplastic disease, right foot) for the encounter.

Myth 2: If Another Provider, Such as an ED, Sees the Patient for the Fracture First, You Cannot Use 7^th Character A

This myth is a little trickier to bust.

The confusion over the way to apply 7th characters such as A (Initial encounter), D (Subsequent encounter), or S (Sequela) to a fracture code stems from the belief that the characters apply to the patient encounter. So, it would be tempting to code M84.374D (Stress fracture, right foot, subsequent encounter for fracture with routine healing) when your podiatrist sees a patient to provide care for a stress fracture of the right foot after the patient has already been seen by a local emergency department (ED).

However, this would not be correct. ICD-10-CM guideline C.19.a states, “While the patient may be seen by a new or different provider over the course of treatment for an injury, assignment of the 7th character is based on whether the patient is undergoing active treatment and not whether the provider is seeing the patient for the first time.” In other words, you can think of the initial encounter 7th character A as an abbreviation for Active — you apply the 7th character not to describe the encounter, but to the stage of care for the patient’s condition.

This means the encounter would not meet the ICD-10-CM criteria for a subsequent encounter, which is defined as an encounter “after the patient has completed active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase.” In this example of fracture care, the patient’s foot has not yet healed; as the patient is still receiving ongoing, active care, the correct 7th character to apply to the code would be A.

Myth 3: Fracture Follow-Ups Require an Encounter Code.

While this myth appears logical, it needs to be busted. To do so, you need look no further than the ICD-10-CM guidelines for aftercare and follow-ups: I.C.21.c.7.

Aftercare: Guideline I.C.21.c.7 tells you that aftercare codes describe “situations when the initial treatment of a disease has been performed and the patient requires continued care during the healing or recovery phase.” But the guideline goes on to tell you that the codes should not be used “for aftercare for injuries. For aftercare of an injury, assign the acute injury code with the appropriate 7th character (for subsequent encounter).”

Follow-up: Guideline I.C.21.c.8 explains the follow-up codes describe “continuing surveillance following completed treatment of a disease, condition, or injury. They imply that the condition has been fully treated and no longer exists. But the follow up codes should not be confused with … injury codes with a 7th character for subsequent encounter, that explain ongoing care of a healing condition.”

In other words, you will “not usually use the Z code for a recheck for an injury because they will normally use the injury diagnosis code with a subsequent encounter. This means the injury, accident, or poisoning is now in the healing stage,” according to Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico.