Podiatry Coding & Billing Alert

Hint: The navicular bone is the keystone of the arch.

Chances are that you see numerous fracture claims in your podiatrist’s office. After all, the human foot is made up of 26 bones, so most patients are bound to experience a fracture at some point.

Reporting for ICD-10-CM can be tricky because you have so many options to choose from, and you are expected to code to the highest specificity. Test yourself on the following common tarsal bone fracture questions to keep your claims in tip-top shape.

First, Define Tarsal Bones for Clarity

Question 1: What are the tarsal bones?

Answer 1: The tarsal bones make up the rear section of the foot. The tarsal bones include the following:

• The talus (also known as the ankle bones)
• The calcaneus (also known as the heel bone)
• The tarsals, which form the arch of the midfoot. These bones include the medial, intermediate, and lateral cuneiforms, the cuboid, and the navicular.

Differentiate Between Calcaneus Versus Talus

Question 2: What is the difference between the calcaneus and the talus?

Answer 2: The calcaneus is located at the bottom of the foot and part of the heel. The talus sits above the calcaneus and at the bottom of the ankle joint. When the patient fractures both the talus and the calcaneus, this is defined as a hindfoot fracture.

Both the talus and the calcaneus are critical to the patient’s ability to walk. Calcaneus fractures are the most common, while talus fractures are more difficult to heal due to the weak blood supply of the talus.

Calcaneal and talus fractures are typically the result of major foot and ankle injuries. High-impact falls or motor vehicle accidents are common causes. With greater impact, one typically finds greater damage.

Report These Codes for Talus Fractures

Question 3: Which ICD-10-CM codes should I report for talus fractures?

Answer 3: You have multiple options to rely on when reporting talus fractures. You should look to S92.101A (Unspecified fracture of right talus, initial encounter for closed fracture)- S92.101S (Unspecified fracture of right talus, sequela).

Example: A patient has a displaced fracture of the posterior process of the right talus. This was an initial encounter for a closed fracture. You should report S92.131A (Displaced fracture of posterior process of right talus, initial encounter for closed fracture) on your claim.

Don’t miss: The talus fracture codes also include the diagnosis for astragalus, according to ICD-10-CM.

Rely on These Dx Options for Calcaneus Fractures

Question 4: Which ICD-10-CM codes should I report for calcaneus fractures?

Answer 4: If a patient has a calcaneus fracture, you also have many ICD-10-CM fractures you may report. You should turn to S92.001A (Unspecified fracture of right calcaneus, initial encounter for closed fracture)-S92.066S (Nondisplaced intraarticular fracture of unspecified calcaneus, sequela).

Example: A patient has a displaced avulsion fracture of the tuberosity of the left calcaneus. This was an initial encounter for a closed fracture. You should report S92.032A (Displaced avulsion fracture of tuberosity of left calcaneus, initial encounter for closed fracture) on your claim.

Don’t miss: You also may see “heel bone” fracture or “os calcis” in the medical documentation when a patient has a calcaneus fracture.

Understand How the Cuboid Functions

Question 5: Why is the cuboid important?

Answer 5: The cuboid helps provide stability of the foot and the movement of the toes, in addition to ensuring proper weight distribution and flexibility along the plantar fascia.

The navicular and the cuboid bones connect the rear foot to the forefoot, says James Werling, PT, DPT, MTC, CFC, IDN cert, physical therapist and owner of Pro Motion Physical Therapy in Raleigh, North Carolina. If the cuboid gets rotated or twisted, mainly due to a rigid foot and an abnormal walking pattern, this can lead to pain on the outside of the foot or referred pain, which could be misdiagnosed as plantar fasciitis or tibias tendinitis.

Pinpoint Correct Codes for Cuboid Fractures

Question 6: Which ICD-10-CM codes should I report for cuboid fractures?

Answer 6: When it comes to reporting cuboid fractures, you should look to codes S92.211A (Displaced fracture of cuboid bone of right foot, initial encounter for closed fracture)- S92.216S (Nondisplaced fracture of cuboid bone of unspecified foot, sequela).

Example: The patient has a displaced fracture of the cuboid bone of the right foot. This was a subsequent encounter for fracture with routine healing. You should report S92.211D (Displaced fracture of cuboid bone of right foot, subsequent encounter for fracture with routine healing) on your claim.

Don’t miss: The 7th character “D” subsequent encounter is used for encounters after the patient has completed active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase, says Jeri L Jordan, CPC, billing manager at Hampton Roads Foot and Ankle in Williamsburg, Virginia. This does not refer to how many times the podiatrist has seen the patient, but rather if the patient is in the healing or recovery phase.

Question 7: What is the navicular bone?

Answer 7: The navicular bone is the keystone of the arch, according to Werling.

The navicular bone is located on the medial side of the foot, and it is important for connecting the ankle to the lower bones in the feet.

When a patient has a rigid navicular bone, they are unable to go from supination to pronation, Werling explains.

Older patients may have problems with their navicular because they often don’t stretch and don’t work on balance, according to Werling. When they go into midstance during gait and they don’t have proper mobility of their arch, the foot becomes rigid and can’t conform to the walking surface. So, if they step on a crack or a stone, they are more likely to lose their balance and fall.