Revenue Cycle Insider

Find out if you need to report activity codes.

Snow, ice, and cold temperatures can contribute to unexpected injuries that could land patients in your podiatrist’s office. Revenue Cycle Insider has pulled together three unique cases that you could see this winter.

Examine the following situations and learn which codes apply.

Solve This Stress Fracture Coding Scenario

Scenario: A 65-year-old patient slipped off an icy sidewalk while walking their dog and injured their left foot. They presented to their podiatrist with pain, swelling, and difficulty standing and walking. The podiatrist ordered three X-ray views of the left foot. After reviewing the images, the podiatrist diagnosed the patient with a stress fracture of the second metatarsal of the left foot.

For this scenario, you’ll assign M84.375A (Stress fracture, left foot, initial encounter for fracture) to report the podiatrist’s documented diagnosis. The M84.3- (Stress fracture) code category requires 5^th, 6^th, and 7^th characters to complete each code for reporting. The 5^th character 7 designates stress fractures of the ankles, feet, and toes. The 6^th character 5 specifies the foot laterality. Lastly, 7^th character A indicates the patient is seeking active treatment for their injury.

Most fractures are classified as either a pathological fracture or a traumatic fracture. The ICD-10-CM Alphabetic Index separates these fracture types.

• Pathological fracture: Break in the bone caused by an infection, disease, or tumor that weakens the bone.
• Traumatic fracture: Occurs when an outside force acts upon the bone to cause the break.

Stress fractures are a type of traumatic fracture. For the scenario presented above, you’ll follow along the indentations in the ICD-10-CM Alphabetic Index listed below:

• Fracture, traumatic > stress > metatarsus

You’ll then turn to the Tabular List to verify the correct metatarsal stress fracture code.

Next, you’ll assign an external cause of injury code to paint the full picture of what the patient was doing when the injury occurred. While most payers won’t reimburse for external cause codes, the codes are used for data collection and can be used for insurance purposes.

“It is always important to add the activity code because it helps provide more clarity about the injury, as well as potentially affect the payer,” says Lauren Braico, CPC, CEDC, medical coding professional in Syracuse, New York. She adds, “However, it is especially important to include on the initial injury visit or with new providers for active treatment as these facilities may not communicate with each other.”

You’ll assign W00.2XXA (Other fall from one level to another due to ice and snow, initial encounter) for this scenario to show that the patient slipping on the icy sidewalk is what caused the injury.

Evaluate an Eversion Ankle Sprain

Scenario: A 25-year-old patient was playing basketball at their local recreation center. The patient jumped to get a rebound and landed on another player’s foot, causing their right ankle to twist. The patient presented to the orthopedist with severe ankle pain and bruising, and the patient was unable to put weight on the joint. The provider ordered ankle X-rays and, after reviewing the images and report, diagnosed the patient with a right eversion ankle sprain.

Anatomy breakdown: An eversion ankle sprain occurs when the ankle rolls inward. This injury is less common than an inversion ankle sprain, where the ankle rolls outward (supination). The eversion ankle sprain involves injuring the deltoid ligament, or the medial ligament of the talocrural joint, of the ankle. This flat, triangular ligament is strong and is made up of four different ligaments that connect the lower end of the tibia to the talus, calcaneus, and navicular.

As mentioned above, an eversion ankle sprain is a sprain of the deltoid ligament. Search the ICD-10-CM Alphabetic Index entries for Sprain > ankle > deltoid ligament, and then verify the code in the Tabular List. In the Tabular List, you’ll find category code S93.42- (Sprain of deltoid ligament) features a 6^th character required icon. The 6^th character identifies the laterality, which in this case is 1 for the right ankle. Additionally, a 7^th character is required to complete the code. You’ll use 7^th character A to signify the patient is seeking active treatment for the injury.

For this scenario, you’ll assign S93.421A (Sprain of deltoid ligament of right ankle, initial encounter) to report the documented diagnosis. You can also assign Y93.67 (Activity, basketball) and Y92.310 (Basketball court as the place of occurrence of the external cause) to report the activity and where the injury occurred. Of course, check with your individual payers to see if they want external cause codes included.

Analyze the Following Arthritis Flareup Case

Scenario: A 68-year-old patient, who has a known history of arthritis, presented to their podiatrist with complaints of increased pain and stiffness in their feet. The patient had been walking in the park earlier in the week when the weather was particularly cold and snowy. After getting home, the patient noticed an exacerbation of their arthritis symptoms. Following a patient history and physical examination, the podiatrist diagnosed the patient with a flareup of their arthritis in the feet due to the chilly weather.

Patients with arthritis can experience flareups of their condition when the frigid winter weather sets in. Freezing temperatures can tighten tissues and muscles in joints, as well as reduce blood flow to the body structures.

Once again, you’ll turn to the ICD-10-CM Alphabetic Index to locate the Arthritis entry. Follow the indentations to specified form NEC, and then foot joint. When you turn to the Tabular List to verify the code, you’ll find M13.87- (Other specified arthritis, ankle and foot), which requires a 6^th character indicating laterality to complete the code. If the documentation states the condition is present in both feet, you’ll assign M13.871 (Other specified arthritis, right ankle and foot) and M13.872 (Other specified arthritis, left ankle and foot).

Mike Shaughnessy, BA, CPC, Development Editor, AAPC