Orthopedic Coding Alert

Once you know what each diagnosis means, finding a dx code will be a snap Don't let anatomic terminology trip up your foot and ankle claims. As long as you know the specifics of each condition in this category, you-ll code foot and ankle services like an ace. Toe, foot and ankle problems can be caused by wear-and-tear, or by sudden injuries, such as those from jumping during sports. "You-ve got to know the differences between these diagnoses, or you may miss a subtle difference and assign the wrong code," says Heather Corcoran, coding manager at CGH Billing in Louisville, Ky. Coding tip: One thing to remember is that you might need modifiers to help differentiate work on different areas of the feet or toes, says Denise Paige, CPC, coding and billing manager at Beach Orthopedic Associates in Long Beach, Calif., and the president-elect of the AAPC's Long Beach Chapter. These modifiers include LT (Left side) and RT (Right side), TA-T9 (for the individual toes), and sometimes 59 (Distinct procedural service), depending on the service your orthopedist provides. These modifiers become particularly important if the physician performs the same procedure on more than one foot or toe. The following primer can help get your foot, ankle and toe diagnosis coding on the straight and narrow. Bunions vs. Hallux Valgus: They Aren't the Same A bunion is an enlargement of bone or tissue around the metatarsophalangeal (MTP) joint. It is often caused by patients wearing shoes that are too narrow around the toe box and can cause pain and deformity of the toes. Keep in mind: A common misconception is that "hallux valgus" and "bunion" are the same thing. Although CPT lists bunion procedure codes, such as 28290 (Correction, hallux valgus [bunion], with or without sesamoidectomy; simple exostectomy [e.g., Silver type procedure]), as "hallux valgus corrections," physicians who perform these aren't necessarily correcting a hallux valgus, according to ICD-9 terminology. If you look up 735.0 (Hallux valgus [acquired]), the definition reads, "Angled displacement of the great toe, causing it to ride over or under other toes." Therefore, you shouldn't report 735.0 unless you-re sure that the patient had a great toe angled in so far that it actually overlapped the other toes. According to this definition, a person could have a bunion but not necessarily a hallux valgus deformity. If the patient's great toe isn't overlapping the second toe, but he still has an obvious bunion, check out 727.1 (Other disorders of synovium, tendon, and bursa; bunion). This code specifically says "bunion," and the ICD-9 definition is "enlarged first metatarsal head due to inflamed bursa; results in laterally displaced great toe." As you can see, this definition does not cover an [...]