Session Title: ICD-10: Real-World Examples With The Foot .
3/24/2014Session Title: ICD-10: Real-WorldExamples With the Foot and AnkleAll rights reservedDavid J. Freedman, DPM, FASPS, CPC, CSFAC, CPMAEmail: djfreedman@icdtenhelp.com Session Objectives: Learn typical ICD-10 coding scenarios for– foot conditions– ankle conditions– lower leg conditions Discuss payer LCDs and ICD-10 coding as itrelates to foot and ankle conditions1
3/24/2014ICD-10 Coding Just A Thought .Can You First Describe A PencilIt is thought to be black and white. I can draw usinga pencil and it describes things through the letters Icreate or the pictures I draw. There also can beshades of grey with a pencil so sometimes there canbe different versions of the same story. Patientsoften tell a different story than what I perceive astheir doctor and what you may perceive being thecoder/biller. Ultimately, it should be their story. Thepencil allows each of us to tell the same story butoften there are different shades of grey.Documentation Starts With a Patient Record2
3/24/20147th Characterand Injuries Non-fracture care A- initial encounter D- subsequentencounter S- sequela Fracture care A- initial encounter (forclosed fracture) B – initial encounter foropen fracture D- subsequent encounterfor normal healingfracture G- subsequent encounterfor delayed healingfracture K- subsequent encounterfor fracture with nonunion P- subsequent encounterfor fracture with malunion S- sequela of fractureICD-10 Coding Scenarios For Foot Conditions Patient presentsto the foot andankle specialistbut there are nofeet or ankles? So what to do?3
3/24/2014Let’s Start With Charting Example #1Diabetic At Risk Foot Care“Initial” Encounter4
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3/24/2014Is there a problem with mapping? It gets you closebut not the actual code most of the spxIn ICD-10-CM There are many types of Diabetes. It is criticalyou know the type of diabetes the patient has. Let’s go over the many options9
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3/24/2014ICD-9 to ICD 10 Coding1) Type 2 DM with neuropathy. ICD9 250.60 and 357.21) E11.42 Type 2 diabetes mellitus withdiabetic polyneuropathyICD-9 to ICD 10 Coding2) Type 2 DM with peripheral vascular disease 250.702) E11.51 Type 2 diabetes mellitus withdiabetic peripheral angiopathy withoutgangrene13
3/24/2014ICD-9 to ICD 10 Coding3) Onychomycosis ICD9 110.13) B35.1 OnychomycosisICD-9 to ICD 10 Coding4) L60.3 Nail Dystrophy14
3/24/2014ICD-9 to ICD 10 Coding5) Corn and Callus ICD9 7005) L84 Corn/CallusIn Summary Based On ICD-10 RulesThe Following Are Coded:1) E11.51 Type 2 diabetes mellitus with diabetic peripheralangiopathy without gangrene2) E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy3) B35.1 Onychomycosis4) L60.3 Nail Dystrophy5) L84 Corn/Callus15
3/24/2014So What If The Patient Has PVD?16
3/24/2014In Summary Based On ICD-10 Rules ToMeet “At Risk Foot Care”The Following Are Coded:1) I73.9 Other peripheral vascular diseases, unspecifiedOR2a) I70.201-Unspecified Atherosclerosis of native arteries ofextremities, right leg2b) I70.202-Unspecified Atherosclerosis of native arteries ofextremities, left leg2c) I70.203-Unspecified atherosclerosis of native arteries ofextremities, bilateral legs3) B35.1 Onychomycosis4) L60.3 Nail Dystrophy5) L84 Corn/CallusJust To Throw Another Twist On ThePVD Front, What If .?There is Claudication1a) I70.211- Atherosclerosis of native arteries of extremities withintermittent claudication, right leg1b) I70.212- Atherosclerosis of native arteries of extremities withintermittent claudication, left leg1c) I70.213- Atherosclerosis of native arteries of extremities withintermittent claudication, bilateral legs17
3/24/2014Just to throw another twist on the PVDFront, what if .?There is rest pain1a) I70.221- Atherosclerosis of native arteries of extremities withrest pain, right leg1b) I70.222- Atherosclerosis of native arteries of extremities withrest pain, left leg1c) I70.223- Atherosclerosis of native arteries of extremities withrest pain, bilateral legs18
3/24/2014Examination Documentation Incurvated medial left hallux nail border. Inflamed, erythematous, purulence, and painmedial nail border left hallux.19
3/24/2014Ingrown Nail 703.020
3/24/2014Cellulitis/Abscess Example Must Look--1006010061Incision and drainage of abscess(eg, carbuncle, suppurativehidradenitis, cutaneous orsubcutaneous abscess, cyst,furuncle, or paronychia); simpleor singleMC 134.9710ICD9:Global 681.10 toeIncision and drainage of abscess(eg, carbuncle, suppurativehidradenitis, cutaneous orsubcutaneous abscess, cyst,furuncle, or paronychia);complicated or multipleMC 236.3310ICD9:Global 681.10 toe681.11ony/par682.7 foot682.6 ankle/leg998.59 Post-op681.11ony/par682.7 foot682.6 ankle/leg998.59 Post-opI&D Abscess (NOT DEEP)21
3/24/2014Examination Documentation The right foot, great toe has erythema, pain,and a cavity with yellow purulence is noted.22
3/24/2014ICD-9 to ICD 10 Coding1) Cellulitis toe ICD9 681.102) Onychia/Paronychia ICD9 681.1123
3/24/2014ICD-9 to ICD 10 Coding1) Cellulitis toe ICD9 681.102) Onychia/Paronychia ICD9 681.111) L03.031 Cellulitis of right toe2) L03.032 Cellulitis of left toe24
3/24/2014ICD-9 to ICD 10 Coding1) Now we have a patient who has a Postoperative infection. ICD9 998.59Examination Documentation The surgical site is evaluated showing the 1stray incision on the left foot dorsally hasdehisced. There is localized erythema andyellow drainage noted.25
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3/24/2014ICD-9 to ICD 10 Coding1)998.59 Post-op1) T81.4xxA Infection following a procedure“Initial Encounter”Note: the laterality, left foot does not play arole in this coding selection, but A,D or Sdoes27
3/24/2014Examination DocumentationIf there is abnormal skin under callousfor a diabetic how is that coded? A history of diabetic ulceration at a site, ie: right foot,plantar 1st metatarsal head reveals non viable tissue“breakdown through skin”. This is abnormal tissueand should be documented as such. Level of debridement depends on whether this area ispartial skin or full thickness (97597 MC RVU 0.51)involvement Vs Office Visit (99212 MC RVU 0.48 or99213 MC RVU 0.97)28
3/24/2014ICD-10-CM, Rules NON-Pressure UlcerL97 Non-pressure chronic ulcer of lower limb, notelsewhere classifiedIncludes:chronic ulcer of skin of lower limb NOSnon-healing ulcer of skinnon-infected sinus of skintrophic ulcer NOStropical ulcer NOSulcer of skin of lower limb NOSICD-10-CM, Laterality and Terminology Level29
3/24/2014Summary For This Patient1. E11.621 - Type 2 diabetes mellitus with footulcer Use additional code to identify site ofulcer (L97.4-, L97.5-)2. E11.42 Type 2 diabetes mellitus with diabeticpolyneuropathy3. L97.511 Non-pressure chronic ulcer of otherpart of right foot limited to breakdown ofskin30
3/24/2014Examination DocumentationIf there is a pressure ulcer how is thatcoded? A history of pressure ulceration at a site, ie: “rightheel” non viable tissue through and includingsubcutaneous tissue. This is abnormal tissue andshould be documented as such. Level of debridement depends on whether this area ispartial skin or full thickness (97597 MC RVU 0.51)involvement Vs Office Visit (99212 MC RVU 0.48 or99213 MC RVU 0.97)ICD-10-CM, Rules Pressure Ulcer31
3/24/2014ICD-10-CM, Laterality and LevelICD-9 to ICD 10 Coding1) Pressure Ulcer, heel 707.071) L89.612 Pressure ulcer of right heel2) No Gangrene so no additional coding32
3/24/2014Rules To Note From Chapter 1333
3/24/2014Rules To Note From Chapter 1934
3/24/2014Examination Documentation Patient presents with a very high arch rightand left foot. The heel does not go past vertical during gait, Analysis shows that the midfoot does nottouch the ground surface when walking. Radiologic Examination-AP, Lateral andOblique views reveals the posterior break inthe cyma line, calcaneal inclination at 30degrees35
3/24/2014Cavus Foot 736.73ICD-9 to ICD 10 Coding1) Cavus Foot 736.73 (No laterality option)1) M21.6x1 Cavus foot, right2) M21.6x2 Cavus foot, left3) No additional coding as no bilateraloption36
3/24/2014Examination Documentation Patient presents with very flat feet. The heel goes into valgus during gait, Analysis shows that the midfoot does touchthe ground surface when walking. Radiologic Examination-AP, lateral and obliqueviews reveals an anterior break in the cymaline, the calcaneal inclination angle is 10degrees. The talocalcaneal angle measures 40degrees.37
3/24/2014Other Acquired Deformity Foot “PronationSyndrome”736.79ICD-9 to ICD 10 Coding1) Other acquired deformity of ankle and foot 736.791) M21.6x1 other acquired deformities offoot, right2) M21.6x2 other acquired deformities offoot, left3) No alternative coding as no bilateraloption exists38
3/24/2014Examination Documentation The right foot, 1st MTPJ has pain on range ofmotion.39
3/24/2014Joint Pain Foot and Ankle 719.47ICD-9 to ICD 10 Coding Joint Pain foot and ankle 719.47 Pain in ankle and joints of right footM25.57140
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3/24/2014Examination DocumentationIntegumentary Examination On inspection and palpation the left foot,dorsal surface near the midfoot exhibits acystic lesion with pale color that is painful ondirect palpation.Benign Neoplasm of Skin 216.742
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3/24/2014Examination DocumentationIntegumentary Examination On inspection and palpation the left foot,plantar surface near the 3rd sulcus exhibits acystic lesion with black pin point capillariesthat is painful on side to side compression.Wart-Verruca Plantaris 078.1244
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3/24/2014Examination DocumentationMusculoskeletal examination On inspection and palpation the left foot, heelpain on direct palpation plantar medialaspect, this exhibits pain only along themedial band of the fascia.Plantar Fasciitis 728.7146
3/24/2014What If You X-ray the Left Foot? Same patient who has heel pain The radiologic exam reveals an inferiorcalcaneal spur on the left foot.47
3/24/2014Calcaneal Spur 726.7348
3/24/2014On ExaminationMusculoskeletal Examination: Inspection and palpation reveals the righthallux in valgus with an enlarged 1stmetatarsal head Range of motion is painful in both dorsiflexionand plantar flexion.49
3/24/2014Hallux Valgus 735.050
3/24/2014On Examination Inspection and palpation reveals thecontracted right 2nd PIPJ with flexion and 2ndMTPJ extension contracture. Pain on range of motion of the PIPJ withflexibility of the joint.51
3/24/2014Hammertoe 735.452
3/24/2014On Examination Inspection and palpation reveals thehypertrophied bony growth at the right 1stmetatarsal-cuneiform joint53
3/24/2014Exostosis 726.9154
3/24/2014On Examination Inspection and palpation reveals thehypertrophied bony growth at the areaplantar to the left tibial sesamoid.55
3/24/2014Sesamoiditis 733.9956
3/24/2014On Examination Inspection and palpation reveals the right 1stMTPJ very edematous, erythematous andpainful joint on range of motion. There is no cavity present There is no cellulitis57
3/24/2014Acute Gouty Arthropathy 274.0158
3/24/2014On Examination Inspection and palpation reveals the right 1stMTPJ very edematous, erythematous andpainful joint on range of motion. There is nowhite chalky material seen.59
3/24/2014Chronic Gouty Arthropathy WithoutMention Of Tophus (Tophi)274.0260
3/24/2014What if Our Chronic Gout PatientExhibits Tophaceous Material at the1st MTPJ Right Foot?61
3/24/2014On Examination Inspection and palpation reveals the left 3rdinterspace has palpable click, pain oncompressing the inter-metatarsal nerve,paresthesias are noted as well.Morton’s Neuroma 355.662
3/24/2014On Examination Inspection and palpation reveals the right heelhas a large nonviable area with black eschar,this is elevated and can probe through this fullskin thickness disruption into subcutaneoustissues. Bloody drainage is noted but nopurulence.63
3/24/2014ICD-9 to ICD 10 Coding1) 707.06 Decubitus ulcer, ankle2) 707.07 Decubitus ulcer, heel3) 707.09 Decubitus ulcer, other site1)2)3)4)5)L89.511- 24L89.891-L89.89464
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3/24/2014Malunion of Fracture 733.81 First Question you have to ask is whereanatomically are we speaking? Malunion Coding went away as a stand alonecode, it is now a component code of thefracture.66
3/24/2014No Individual ICD 10 CodeNonunion of Fracture 733.82 First Question you have to ask is whereanatomically are we speaking? Nonunion Coding went away as a stand alonecode, it is now a component code of thefracture.67
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3/24/2014On Examination Inspection and palpation reveals the right 2ndmetatarsal is painful on palpation with andedematous forefoot. Radiologic Examination, AP, Lateral and MedialOblique views reveals a closed obliquefracture that is non-displaced.RULES69
3/24/20142nd Metatarsal Fracture, Initial Encounter2nd Metatarsal Fracture, SubsequentEncounter, Routine Healing70
3/24/20142nd Metatarsal Fracture, SubsequentEncounter, Delayed Healing2nd Metatarsal Fracture, SubsequentEncounter, Malunion Healing71
3/24/20142nd Metatarsal Fracture, SubsequentEncounter, Nonunion Healing72
3/24/2014On Examination Inspection and palpation reveals the right 1stmetatarsal is painful on palpation with anoted prominence dorsally where the screwwas inserted 10 years ago Radiologic Examination, AP, Lateral and MedialOblique views of the right foot reveals asurgical screw that has backed itself out by5mm.Other Mechanical Complication of Other InternalOrthopedic Device, Implant, and Graft 996.49RULES73
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3/24/2014On Examination Inspection and palpation reveals the rightsubtalar joint a very edematous and swollenarea, very painful on palpation and the jointappears to be medially deviated Radiologic Examination, AP, Lateral and MedialOblique views of the right foot reveals a thesubtalar joint no longer in alignment, this jointis medially displaced.Dislocation of Foot, Closed, Tarsal Joint 838.01 But the Code requires A,D, S so .75
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3/24/2014ICD-10 Coding Scenarios for Ankle ConditionsExamination Documentation Patient presents after walking around theamusement park with a weak left ankle, onexamination, the ankle mortise does not holdthe talus stable, the talus can easily go intovarus when stressed.77
3/24/2014Ankle Instability 718.8778
3/24/2014What Do You Do When You Go To Disney?Y33 Other specified events,undetermined intentThe appropriate 7th characteris to be added to code Y33 A - initial encounter D - subsequent encounter S – sequela.Code Y33.xxxA(Dummy character in 4th, 5thand 6th place)ICD-9 to ICD 10 Coding1) Ankle Instability 718.871) M25.372 other instability of joint, ankle2) Y33.xxxA Other specified events,undetermined intent79
3/24/2014On Examination at Later Date Inspection and palpation reveals the rightankle joint a very edematous and swollen,very painful on palpation and the jointappears to be anterior displaced as a result ofthe severe ankle sprain. Radiologic Examination, AP, Lateral and MedialOblique views of the right ankle reveals a theankle joint is not in alignment, this joint isanterior displaced.80
3/24/2014Recurrent Dislocation of Joint AnkleAnd Foot 718.3781
3/24/2014Examination Documentation Patient presents with a stiff left ankle, onexamination, the ankle exhibits crepitus, andpain on range of motion. X-rays revealed joint space narrowing of theankle joint with sclerotic bone and exostosesin the ankle joint.Ankle Arthritis ICD9-715.17RULES82
3/24/2014Ankle Arthritis ICD9- 715.17Right or Left? Now let’s look at the laterality ankle and foot83
3/24/2014ICD-9 to ICD 10 Coding1) Ankle osteoarthritis, localized 715.171) M19.072 Primary osteoarthritis ankleand foot, left84
3/24/2014On Examination Inspection and palpation reveals the rightTibialis Posterior tendon is painful along themedial aspect of the tibia and painful as itcourses at the ankle.Tibialis Tendonitis 726.7285
3/24/2014On Examination Inspection and palpation reveals the rightTibialis Posterior tendon is painful along themedial aspect of the tibia and painful as itcourses at the ankle. In addition there is apalpable fluctuance within the tendon sheath.86
3/24/2014Tenosynovitis of Foot and Ankle 727.0687
3/24/2014On Examination Inspection and palpation reveals the rightPosterior Tibial Nerve is painful along themedial aspect of the tibia at the ankle andpainful as it courses below the ankle as itcourse into the foot. Percussion of the nerveelicited paresthesias distally.Tarsal Tunnel Syndrome 355.588
3/24/2014On Examination Inspection and palpation reveals the rightankle is erythematous, increased temperaturewith localized pain. There is a cavity presentwith yellow purulence.89
3/24/2014ICD-9 to ICD 10 Coding1) Cellulitis or Abscess ankle/leg ICD9 682.62) Cellulitis or Abscess Foot ICD0 682.790
3/24/2014On Examination Inspection and palpation reveals the rightankle primarily along the fibula it iserythematous, has increased temperaturewith localized pain. There is an ulcer thatprobes to bone. Radiologic examination, AP, Lateral andOblique views reveal destructive changes tothe lateral malleolus.91
3/24/2014Osteomyelitis Example92
3/24/2014ICD-9 to ICD 10 Coding1) 730.07 Bone-Acute1) M86.071 Acute hematogenousosteomyelitis, right ankle and foot2) M86.072 Acute hematogenousosteomyelitis, left ankle and foot3) M86.171 Other acute osteomyelitis, rightankle and foot4) M86.172 Other acute osteomyelitis, leftankle and foot93
3/24/2014On Examination Inspection and palpation reveals the rightankle distal fibula has a chronic draining area,erythematous, increased temperature withlocalized pain. There is an ulcer that probes tobone. Radiologic examination, AP, Lateral andOblique views reveal destructive changes tothe lateral malleolus with sclerotic changes.94
3/24/2014ICD-9 to ICD 10 Coding1) 730.17 Bone-Chronic1) M86.471 Chronic osteomyelitis withdraining sinus, right ankle and foot2) M86.472 Chronic osteomyelitis withdraining sinus, left ankle and foot3) M86.671 Other chronic osteomyelitis, rightankle and foot4) M86.672 Other chronic osteomyelitis, leftankle and foot95
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3/24/2014On Examination Inspection and palpation reveals the leftlateral lower leg along the ankle and ending atthe base of the 5th metatarsal reveals aparesthesia when percussing the Sural nerve.Neuritis 729.298
3/24/2014ICD-9 to ICD 10 Coding1) Cellulitis or Abscess ankle/leg ICD9 682.6Examination Documentation Patient presents with an ascendingerythematous, increased temperature to theright ankle and lower leg.99
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3/24/2014ICD-9 to ICD 10 Coding1) 682.6 Cellulitis ankle/leg2) 682.7 Cellulitis Foot1) L03.115 Cellulitis of right lower limb2) L03.116 Cellulitis of left lower limb3) L03.125 Acute lymphangitis of right lowerlimb4) L03.126 Acute lymphangitis of left lowerlimb101
3/24/2014Examination Documentation Musculoskeletal examination reveals minorpain and edema at the insertion of the leftAchilles tendon The patient can raise up on their toes whenattempting to ambulate but exhibits somepain.102
3/24/2014Sprains and strains of Achilles tendon 845.09RULES103
3/24/2014Examination Documentation-What ifThere is More Than a Strain? Musculoskeletal examination revealssignificant pain and edema at the insertion ofthe left Achilles tendon The patient cannot raise up on their toeswhen attempting to ambulate without pain.Achilles Tendonitis 726.71104
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ICD-10-CM, Rules Pressure Ulcer . 3/24/2014 32 ICD-10-CM, Laterality and Level ICD-9 to ICD 10 Coding 1) Pressure Ulcer, heel 707.07 1) L89.612 Pressure ulcer of right heel 2) No Gangrene so no additional coding . 3/24/2014 33 Rules To Note From Chapter 13 . 3/24/2014 34
ICD-9 724.02 ICD-10 M48.06 Spinal stenosis, lumbar region ICD-9 720.2 ICD-10 M46.1 Sacroiliitis, not elsewhere classified ICD-9 724.8 ICD-10 R29.898 Other symptoms and signs involving the ** musculoskeletal system ICD-9 721.42 ICD-10 M47.16 Other spondylosis with myelopathy, lumbar region ICD-9 723.1 ICD-10 M54.2 Cervicalgia ICD
More on ICD-10. ICD-10-PCS replaces ICD-9-CM inpatient procedure coding: ICD-9-CM procedure codes 3 to 4 numeric digits ICD-10-CM codes 7 alphanumeric digits ICD-10-PCS code format substantially different from ICD -9 Unlike ICD-9, ICD-10
ICD-10 Tips from PHCS The Road to ICD-10 Flyer AMA ICD-10 Project Plan Template Educational Tools Folder Precyse University ICD-10 Physician Office Solution Brochure Precyse Catalog of ICD-10 Courses ICD-10 Precyse Apps for Physicians Resources Folder Free Resources ICD-9 to ICD-10 Crosswalk of Most Common ICD-9 .
Dec 14, 2010 · ICD-9. ICD-10. ICD-9. ICD-10. Inactive. Active. Combined Code Set. Core Technologies. ICD-9 and ICD-10 code values are unique. Generally, the industry is taking one of two approaches as it relates to the ICD-10 transition: Remediation: Modify/expand all systems and processes to accommodate ICD-
ICD-10 to ICD-10-CM Based on FY2017 ICD-10-CM codes Category and subcategory codes are shaded in grey and marked with an Cells shaded in pink and marked with an *indicate the preferred code when a single code maps to multiple codes (see Introduction) Reportable Neoplasms . Type of Code ICD-10 Category Chapter II (Neoplasms) ICD-10 Term . ICD .
by multiple ICD-10 codes or a cluster of ICD-10 codes may be required to describe a single ICD-9 code Some concepts will be lost when translating between ICD-9 and ICD-10 Substance Dependence concept has been removed from ICD-10 Substance Use is now defined by specific substance Overall, by using ICD
7/13/2015 1 Tonya Mitchell, RHIT July 17, 2015 Objectives Review the History of ICD‐10 Discuss the Myths and Facts of ICD‐10 Discuss GlGeneral DttiDocumentation CtConcepts Review ICD‐10 Documentation Concepts Analyze Documentation for Top Diagnosis in ICD‐10 WHY CHANGE FROM ICD‐9 TO ICD‐10? ICD‐9 was developed in the 1970s and cannot support current
of the previous ICD-9 coding system. The volume of ICD-10 codes as compared to ICD-9 codes is significant because in ICD-10, the code size has been expanded, code values and interpretations have been redefined and specificity has been further improved. Global ICD-10 adoption The current version of ICD is ICD-10, which was adopted by the World .
