Orthopedic Coding Alert

Question: If a child is referred to me by his or her pediatrician for clubfoot and is in fact normal, how do I code the office visit?

Christopher J. Zielinski, MD
Culpeper, Va.

Answer: This is a typical question that plagues providers and coders how to code for the rule-out (R/O). Try following one of the two following choices:

1. Code for the sign/symptom, such as 719.57 (stiffness of joint, not elsewhere classified, foot and ankle). The pediatrician must be asking for this consult because the child has displayed some sign/symptom that might indicate club foot. It is acceptable to report signs/symptoms versus findings.

2. Code V71.8 (observation for other specified suspected conditions). The problem with this code as a stand-alone is that many carriers will not pay for this under ICD-9. This is a case in which you want the responsible party to agree, in writing, to pay for this if the carrier denies the payment.