Podiatry Coding & Billing Alert

Hint: Identify type of encounter to choose appropriate 7^th character.

Since ICD-10-CM offers so many options for specificity, it can be tricky to choose the appropriate code. This is especially true for fractures, like a Jones fracture. When you report Jones fractures, you must check the medical documentation for details such as if the fracture was displaced or nondisplaced.

Answer the following questions to keep your Jones fracture claims in tip-top shape.

First, Define Jones Fracture for Clarity

Question 1: What is a Jones fracture?

Answer 1: A Jones fracture is a diaphyseal fracture of the fifth metatarsal bone of the foot. This fracture usually occurs at the proximal end of the bone or styloid process of the fifth metatarsal, says Arnold Beresh, DPM, CPC, CSFAC, in West Bloomfield, Michigan.

A Jones fracture may cause pain and swelling on the lateral side or middle of the foot, and the patient may complain of difficulty in walking.

A Jones fracture is difficult to heal and is usually caused by an inversion injury to the foot, or when the foot and ankle twists inward. Sometimes patients mistake a Jones fracture for a sprain or strain, so the injury may go undetected, which further increases the potential for nonunion of the fracture.

Diagnostic imaging may include X-ray, CT, or bone scan.

Rely on These ICD-10-CM Codes for Jones Fracture

Question 2: What ICD-10-CM code options do I have for a Jones fracture?

Answer 2: You have multiple ICD-10-CM options for a Jones fracture. They are as follows:

• S92.351A (Displaced fracture of fifth metatarsal bone, right foot, initial encounter for closed fracture)-S92.351S (Displaced fracture of fifth metatarsal bone, right foot, subsequent encounter for fracture with malunion)
• S92.352A (Displaced fracture of fifth metatarsal bone, left foot, initial encounter for closed fracture)- S92.352S (Displaced fracture of fifth metatarsal bone, left foot, sequela)
• S92.353A (Displaced fracture of fifth metatarsal bone, unspecified foot, initial encounter for closed fracture)- S92.353S (Displaced fracture of fifth metatarsal bone, unspecified foot, sequela)
• Displaced fracture of fifth metatarsal bone, unspecified foot
• S92.354A (Nondisplaced fracture of fifth metatarsal bone, right foot, initial encounter for closed fracture)- S92.354S (Nondisplaced fracture of fifth metatarsal bone, right foot, sequela)
• S92.355A (Nondisplaced fracture of fifth metatarsal bone, left foot, initial encounter for closed fracture)-S92.355S (Nondisplaced fracture of fifth metatarsal bone, left foot, sequela)
• S92.356A (Nondisplaced fracture of fifth metatarsal bone, unspecified foot, initial encounter for closed fracture)- S92.356S (Nondisplaced fracture of fifth metatarsal bone, unspecified foot, sequela)

Focus on Seventh Character Options

Question 3: When I was looking through my ICD-10-CM manual, I saw that the Jones fracture codes have a seventh character option. What are the different seventh characters?

The seventh character indicates the kind of encounter for the fifth metatarsal fracture codes. Your options for the seventh character are:

• “A” — initial encounter for closed fracture
• “B” — initial encounter for open fracture
• “D” — subsequent encounter for routine healing
• “G” — subsequent encounter for delayed healing
• “K” — subsequent encounter for nonunion
• “P” — subsequent encounter for malunion
• “S” — sequela (pathological fracture for a fracture caused by a disease process or a late effect)

Pinpoint Treatment Options for Jones Fracture

Question 4: What are the treatment options for a Jones fracture?

Answer 4: For initial treatment, Jones fractures can be treated by casting or bracing, or using a stiff-soled shoe if the fracture is nondisplaced.

If your podiatrist needs to perform surgery, then they may place a screw or plate fixation. Your podiatrist will usually treat a nonunion Jones fracture by open reduction and internal fixation (ORIF) and grafting.

If your podiatrist performs surgery for the Jones fracture, you have some of the following options:

• 28470 (Closed treatment of metatarsal fracture; without manipulation, each)
• 28475 (Closed treatment of metatarsal fracture; with manipulation, each)
• 28476 (Percutaneous skeletal fixation of metatarsal fracture, with manipulation, each)
• 28485 (Open treatment of metatarsal fracture, includes internal fixation, when performed, each).