Podiatry Coding & Billing Alert

Question: Our podiatrist frequently sees sportspersons in our office. Recently he mentioned “easy bruising” in his clinical notes. Is there any specific diagnosis code for easy bruising? Also, which diagnosis code is best for bruises in the heel that our physician diagnosed for a soccer player?

Washington Subscriber

Answer: Easy bruising is not a diagnosis, but rather a symptom. Therefore, the ICD-10 code depends on whether or not the podiatrist identified a cause. If a cause is identified, then code for the specific disease. If, however, no cause is pinpointed, then code for the symptoms.

For easy bruising with no identifiable cause, report R23.3 (Spontaneous ecchymoses). An individual may be suffering from other diseases (or may in sports such as soccer) that predispose him to develop bruises even with minimal trauma (such as a light rap on the feet), which otherwise will not happen to normal people, hence resulting in “easy bruising.” Diseases that could result in this include platelet or coagulation disorders (thrombocytopenias), bone marrow disorders, hemophilias, liver diseases, and Marfan’s syndrome. Aging and medications (for example, aspirin, prednisone, and other nonsteroidal antiinflammatory drugs) can also cause easy bruising. For patients suffering from these conditions, bruises seem to spontaneously appear without any identifiable reason.

An ecchymosis is a bruise larger than 1 centimeter. A bruise less than 1 centimeter but not less than 3 millimeters is called a purpura. A bruise less than 3 millimeters is called a petechiae. Code R23.3 applies also to petechia but not purpura, which has several other codes (287.0-287.9) depending on the etiology.

Bruises resulting from trauma can occur due to a variety of reasons, including falls, accidents, and post-surgeries. In general, use codes from the S90 (Superficial injury of ankle, foot and toes) family for bruises secondary to trauma. For example, in your case of the soccer player who was seen by the physician for bruises in the heel, you may use either of the codes S90.30XA (Contusion of unspecified foot, initial encounter), S90.31XA (Contusion of right foot, initial encounter) or S90.32XA (Contusion of left foot, initial encounter). Note that, as per ICD-10, these codes are for the initial visit only and you should appropriate corresponding codes according to subsequent visits. The above codes exclude contusions that are incidental to specific categories of injuries, such as dislocation and sprain (S93.0-S93.6), fracture (S92.0-S92.9), crushing injury (S97.0-S97.8), nerve injury (S94.0-S90.9), and open wound (S90.1-S90.3).