Podiatry Coding & Billing Alert

Question: Our podiatrist saw a 72-year-old man for a fracture of the right foot. He was originally diagnosed with left upper lobe carcinoma five years ago, and then several months ago, he was diagnosed with metastatic bone cancer (from the lung). This foot fracture is a result of the metastatic cancer. The patient’s lung cancer has already been treated with radiation, and the patient no longer has any evidence of an existing primary malignancy. What ICD-10 code(s) should I report?

Florida Subscriber

Answer: In this scenario, the pathological fracture to the shaft of the patient’s right foot was due to neoplastic disease. Begin with category M84- (Disorder of continuity of bone), and then pinpoint the reason behind the fracture for the code’s fourth character. Your choices are 3 (Stress fracture); 4 (Pathological fracture, not elsewhere classified); 5 (Pathological fracture in neoplastic disease); 6 (Pathological fracture in other disease), 8 (Other disorders of continuity of bone); or 9 (Disorder of continuity of bone, unspecified). You’ll choose 5 in this example because the patient’s fracture is due to a neoplastic disease.

The next two characters of the code indicate the location of the fracture. You have nine general anatomic sites from which to choose, then will drill down to a more specific location. For this patient you’ll select 7 for “ankle and foot,” then 4 for “right foot.”

You’re instructed to also include a seventh character indicating the level of encounter. That information might not be in the podiatrist’s record, so you may need to query the provider to verify what to list as the code’s seventh character (such as A for “initial encounter for fracture”).   

Solution: In this scenario, the pathologic fracture to the right foot was due to neoplastic disease. Therefore, the ICD-10 solution is:

• M84.574A (Pathological fracture in neoplastic disease, right foot, initial encounter for fracture)
• C79.51 (Secondary malignant neoplasm of bone)
• Z85.118 (Personal history of other malignant neoplasm of bronchus and lung)
• Z92.3 (Personal history of irradiation).