3 Definitive Coding Answers to Bank Your Podiatry Pay

Posted on 21 May, 2019 |comments_icon 0|By Elizabeth Debeasi
Take advantage of expert podiatry coding guidance for sure-footed reporting.

Podiatry coding is becoming increasingly complicated, and even the smallest reporting mistakes can lead to claim denials and reduced reimbursement. Worse, the stakes tend to escalate, with minor unchecked errors taking a major bite out of your bottom line.

If your podiatry practice is like most, you can’t afford to leave money on the table. That’s why we asked Meagan Williford, editor-in-chief of TCI’s Podiatry Coding Alert, and podiatry coding veteran, Arnold Beresh, DPM, CPC, CSFAC, to answer key questions from podiatry coders like you.

Question 1: Grasp the Distinction Between Traumatic, Stress, and Pathological Fractures

I am not sure if I understand the difference between traumatic, stress, and pathological fractures and the importance of knowing this when reporting ICD-10 codes. Can you please explain?

Answer: When you are reporting fractures, it’s vital to look at the documentation and see what type of fracture the patient has because your ICD-10 coding choices will be different.

Traumatic: A fracture is considered traumatic when it is caused by some type of accident, fall, or other kind of force, such as when a heavy object strikes a patient. For example, a patient was in a car accident and suffered from a closed, displaced fracture of his medial malleolus in his right tibia. This is a traumatic fracture.

For traumatic fractures for podiatry patients, you would look to S82- (Fracture of lower leg, including ankle) and S92- (Fracture of foot and toe, except ankle).

Example: In the above scenario, for the initial encounter, you would report S82.51XA (Displaced fracture of medial malleolus of right tibia, initial encounter for closed fracture).

Stress: In the case of stress fractures, tiny cracks in the bone result from repetitive force or overuse. These often occur in normal or metabolically weakened bones.

Example: According to the documentation, the podiatrist diagnoses the patient with a stress fracture in his left toe, initial encounter. You would report M84.378A (Stress fracture, left toe(s), initial encounter for fracture).

Pathological: A pathological fracture is a broken bone caused by disease, rather than trauma. If you are reporting a pathological fracture, it’s absolutely necessary to make sure the documentation states the underlying cause of the disease.

Example: A patient, who has age-related osteoporosis, suffers 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).

Question 2: Note If Podiatrist Used Manipulation for Pilon/Plafond Fracture

According to the medical documentation, the patient has a Pilon/Plafond fracture of the weight bearing articular portion of his distal tibia. The podiatrist treated the fracture using closed treatment, without manipulation. The podiatrist administered anesthesia. Which CPT® code should I report for this service?

Answer: You should report 27824 (Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia; without manipulation).

With manipulation: On the other hand, if the podiatrist treated the Pilon/Plafond fracture with closed treatment and the fracture did require manipulation, then you would report 27825 (Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia; with skeletal traction and/or requiring manipulation).

Note: An external fixator is often applied for stabilization of a pilon fracture after closed reduction when future open treatment is planned.

Pilon/Plafond fractures defined: Pilon fractures, also called Plafond fractures, are fractures of the distal part of the tibia, involving its articular surface at the ankle joint. Pilon fractures are caused by rotational or axial forces, usually a result of falls from a height or car accidents.

Question 3: Rely on E/M Code for This Splinter Removal

Using forceps and a needle, the podiatrist removed a splinter from a patient’s foot. Can I use 10120, or would 28190 be more appropriate as it specifically refers to a removal from the foot without an incision?

Answer: The key to this scenario lies in the term “incision.” The procedure you describe does not involve your provider making an incision, so 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) would not be appropriate. Code 28190 (Removal of foreign body, foot; subcutaneous) does not specifically mention an incision, but it does refer to the depth that the foreign body is located in the patient’s foot, which is more than superficial.

You don’t mention how deep your provider went to remove the splinter, but the fact that he removed the splinter with forceps and a needle, and not a scalpel, suggests that it was not deeply embedded in the foot. This, and the fact that the provider used a non-invasive procedure, suggests that you should code this encounter as a low-level evaluation and management (E/M) service from 99201-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …).

Contributing Editor: Meagan Williford
Learn More

Find the help you need to secure optimum reimbursement with your monthly subscription to Podiatry Coding Alert. Every issue of this indispensable resource delivers high-impact tips and guidance — and answers to reader questions like these — as our experts tackle the revenue-risking challenges that threaten your claims and compliance success.

The Coders’ Specialty Guide 2019: Podiatry includes all CPT® and HCPCS codes relevant to podiatry, simple descriptions that explain each code, expert advice for assigning codes, Medicare reimbursement details, diagnosis codes crosswalk, applicable modifiers, CCI edits, global days, code index, hundreds of anatomical illustrations, and more.


Elizabeth Debeasi
Marketing Writer/ Editor

Elizabeth works on an array of projects at TCI, researching and writing about modern reimbursement challenges. Since joining TCI in 2017, she has also covered the nuts and bolts of cybersecurity, compliance with federal laws, and how to tap into the advantages of Telehealth services.

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