Podiatry Coding & Billing Alert

Question: A patient presented with pain in the heel, bleeding, tenderness, stiffness, inflammation, and restricted motion. Upon examination it was found to be an open, but superficial wound which required immediate control of bleeding; thorough cleaning of the wound, surgical removal of damaged or infected tissue, and repair of the wound; and application of appropriate topical medication and dressing. The patient said she had a diabetic condition. How should we code the encounter?

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Answer: Podiatrists cannot diagnose non foot-related diseases and disorders, such as diabetes, because they can’t treat the disease entity — they can treat only the side effects, such as open wounds. There are specific codes for open wound of heel too. Look at these diagnosis codes:

• S91.302A — Unspecified open wound, left foot, initial encounter
• S91.302D — Unspecified open wound, left foot, subsequent encounter
• S91.302S — Unspecified open wound, left foot, sequela
• S91.301A — Unspecified open wound, right foot, initial encounter
• S91.301D — Unspecified open wound, right foot, subsequent encounter
• S91.301S — Unspecified open wound, right foot, sequela
• S91.309A — Unspecified open wound, unspecified foot, initial encounter
• S91.309D — Unspecified open wound, unspecified foot, subsequent encounter
• S91.309S — Unspecified open wound, unspecified foot, sequela

7^th character: At the end of the six-character ICD-10 codes above, you will add a character describing whether it is an initial encounter (A), subsequent encounter (D), or sequela (S). Example: An initial counter for a puncture wound with foreign body of the left foot would be coded S91.342A.

“This description is very vague and difficult to code without at least the size and depth of the wound and it does not mention bone debridement. The only choice is 97597 (Debridement [e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps], open wound, [e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm], including topical application[s], wound assessment, use of a whirlpool, when performed and instruction[s] for ongoing care, per session, total wound[s] surface area; first 20 sq. cm or less,) — though this code is not heel specific,” says Arnold Beresh, DPM, CPC, CSFAC, of Dr. Arnold Beresh, PLC of Newport News, VA.

“If there was better documentation, then the 11042 (Debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; first 20 sq. cm or less), or 11043 (Debridement, muscle and/or fascia [includes epidermis, dermis, and subcutaneous tissue, if performed]; first 20 sq. cm or less,) or 11044 (Debridement, bone [includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed]; first 20 sq. cm or less), codes could have been used… There would have been more pay too,” he adds.

Remember, you shouldn’t confuse the depth of debridement with the depth of the wound. Code 11042’s definition includes “skin and subcutaneous tissue” but does not include the muscle and bone.

Heads up: The debridement code includes reimbursement for the dressing application, so you may not code separately for that service. Routine dressing and supplies are bundled into the debridement code. You should pick a debridement code (11042-11044) only if the podiatrist leaves the wound open, rather than making an excision. The surgeon may choose to leave the wound open in anticipation of healthy tissue growing over.