Podiatry Coding & Billing Alert

Question: I’m new to podiatry coding. Could you please explain the difference between stress, pathological, and traumatic fractures? Also, are there any ICD-10 codes I should look at for fractures?

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Answer: It’s crucial to thoroughly review your podiatrist’s medical documentation when a patient has a fracture because you’ll need to report distinct ICD-10 codes for each type of fracture. In other words, you must pay close attention to the details in the documentation to accurately assign the appropriate codes for different fracture types. This is essential for proper coding and billing purposes. So, be sure to double-check and meticulously analyze the podiatrist’s documentation to ensure accurate code selection for each specific fracture.

Stress fractures defined: Stress fractures are tiny cracks in the bone caused by repetitive stress or force, often from overuse. These normally occur in healthy or metabolically weakened bones. Many patients may have a stress fracture without even realizing it. When a patient has a stress fracture, they usually complain of pain that is nagging or gradually building. You would look to M84.37- (Stress fracture, ankle, foot and toes) to report stress fractures of the foot.

Pathological fractures defined: When a fracture is caused by a disease instead of trauma, it is referred to as a pathological fracture. It is crucial to carefully review the documentation for the underlying cause of the disease when reporting a pathological fracture. This is because specific diseases, such as osteoporosis or neoplastic diseases, can lead to the fracture. Therefore, it’s important to ensure accurate code assignment by thoroughly examining the documentation for the precise disease that caused the pathological fracture.

For example, the medical documentation indicates that your podiatrist saw a patient with age-related osteoporosis who is suffering from a current pathological fracture of her left ankle. This is a subsequent encounter with delayed healing. You would report M80.072G (Age-related osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with delayed healing) on your claim.

Traumatic fractures defined: Fractures are classified as traumatic when they result from accidents, falls, or any form of external force, such as being struck by a heavy object. In other words, a fracture is considered traumatic when it occurs due to an incident or event that causes physical impact or force on the patient’s body. To code traumatic fractures for podiatry patients, you should look to categories S82- (Fracture of lower leg, including ankle) and S92- (Fracture of foot and toe, except ankle) to choose the appropriate ICD-10 code for the diagnosis, adding a code(s) from the External causes of morbidity (V00-Y99) chapter of ICD-10 as appropriate to describe the cause of the trauma.