Podiatry Coding & Billing Alert

Time to find out if you really are an ICD-10-CM expert.

Once you’ve answered the quiz questions on page 3, compare your answers with the ones provided below.

Untangle Congenital Hammertoe Code

Answer 1: You should look to code Q66.89 (Other specified congenital deformities of feet) for congenital hammertoe. If you look in your ICD-10-CM manual under Q66.89, you will see that this code covers the following conditions, including congenital hammertoe:

• Congenital asymmetric talipes
• Congenital clubfoot NOS
• Congenital talipes NOS
• Congenital tarsal coalition
• Hammer toe, congenital

Even though this code seems nonspecific, it is still the preferred code when reporting a congenital condition rather than reporting the standard hammertoe codes (M20.-), because you want to ensure that the payer understands your podiatrist was addressing a congenital condition.

Don’t Fall Flat When Coding Fallen Arches

Answer 2: Depending on the foot affected, you’ll look to a code from the Q66 (Congenital deformities of feet) series for this condition.

When a patient suffers from flat feet (also called pes planus or colloquially as fallen arches), the arches, or medial borders, of their feet have collapsed, with the entire sole of the foot coming into complete, or near complete, contact with the ground.

In ICD-10-CM, flat foot is typically coded with the M21.- (Other acquired deformities of limbs) series, but when the patient has congenital flat foot, you’ll instead choose from the following three codes:

• Q66.50 (Congenital pes planus, unspecified foot)
• Q66.51 (… right foot)
• Q66.52 (… left foot)

Keep in mind that you should only rarely report Q66.50. In most cases, your podiatrist should be documenting which foot they addressed during an encounter.

Understand Os Trigonum Coding

Answer 3: You should report ICD-10-CM code Q68.8 (Other specified congenital musculoskeletal deformities) for os trigonum syndrome.

Posterior ankle impingement syndrome (PAIS) is a term used to describe a musculoskeletal disorder created from the repeated abutment of the posterior process of the talus or os trigonum between the tibia and calcaneus during plantar flexion of the ankle.

The os trigonum is an extra (accessory) bone that lies behind the ankle joint that exists when one area of bone does not fuse with the rest of the talus (ankle bone) during growth. The os trigonum varies in size, and it is attached to the posterior aspect of the talus by a fibrous band of tissue.

When the os trigonum is the cause, the condition is described as os trigonum syndrome. Podiatrists might also refer to this condition as talar compression syndrome, PAIS, or posterior tibiotalar impingement syndrome (PTTIS).

Capture Syndactyly Codes

Answer 4: This is another case where the podiatrist should ideally provide you with more detail than simply describing the patient with the term “syndactyly.” This term describes a patient whose fingers or toes are either fused or webbed. Although most podiatry coders can assume that the patient suffers from a toe abnormality rather than one affecting the fingers, you cannot assume whether the patient’s toes are webbed or fused.

Here’s the difference: Webbed toes are also referred to as partially fused, because they’re typically only connected for part of the way up the toe. Fused toes, however, are completely connected. It’s up to the podiatrist to make the clinical determination of whether the patient has webbed or fused toes.

You also have the option of reporting a code for polysyndactyly, which is when a patient has an extra toe fused to one of their toes. And in cases when you cannot get more information from the podiatrist about the condition, you can report a code for unspecified syndactyly.

Depending on the ultimate diagnosis, you’ll likely choose from the following codes when reporting syndactyly:

• Q70.2- (Syndactyly; Fused toes)
• Q70.3- (Syndactyly; Webbed toes)
• Q70.4 (Polysyndactyly, unspecified)
• Q70.9 (Syndactyly, unspecified)

Extra character alert: Note that the Q70.2 and Q70.4 codes have a dash after the final character. That’s because these codes require a 5th character to denote the affected foot. The 5th character options are:

• 0: Unspecified foot
• 1: Right foot
• 2: Left foot
• 3: Bilateral

So if your patient has webbed toes on their left foot, you’ll report Q70.32 to represent the diagnosis.

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