ED Coding and Reimbursement Alert

Question: A 28-year-old patient visited our urgent care facility with complaints of right ankle pain after a snowboarding trip the previous weekend. The report indicates the patient is walking with a significant limp and presents swelling in the ankle, extreme tenderness in the area, bruising, and sensitivity to pressure at the back of the ankle. The radiologist initially captured three views of the ankle. The attending provider evaluated the images and ordered follow-up CT scans without contrast for further examination. The CT scans revealed a non-displaced LPTF, which the provider diagnosed as snowboarder’s ankle.

I’m not seeing snowboarder’s ankle in the ICD-10-CM code set. What codes do I need to report the diagnosis?

Nevada Subscriber

Answer: You’ll use S92.144A (Nondisplaced dome fracture of right talus, initial encounter for closed fracture) to document the patient’s diagnosis. Snowboarder’s ankle is a term used to describe the fracture of the lateral process of the Talus (LPT). The abbreviation LPTF in the physician’s documentation stands for fracture of the lateral process of the Talus.

In the Alphabetic Index of the ICD-10-CM code set, you’ll start with Fracture, traumatic (abduction) (adduction) (separation) and follow the indentations along tarsal bone(s) > talus > lateral process > nondisplaced, where you’ll find S92.14.

When you open the tabular list, you’ll find S92.14 (Dome fracture of talus) carries a 6th character required icon. The patient suffered a fracture to their right talus, so you’ll choose S92.144 (Nondisplaced dome fracture of right talus).

Don’t forget: S92.144 requires a 7th character, which you must choose based on whether the fracture is open or closed and whether the encounter is initial, subsequent, or sequela. As you didn’t indicate if the fracture was open or closed, you must follow the notes for parent code S92.- (Fracture of foot and toe, except ankle), which tell you that “a fracture not indicated as open or closed should be coded to closed.” Additionally, you noted the patient visited your facility on their own, indicating this is an initial encounter. Putting this all together, you’ll choose 7th character A to indicate an initial encounter with a closed fracture.