Podiatry Coding & Billing Alert

Location and cause of injury hold the key.

Before you begin to code an encounter where your podiatrist treated a patient for deep tissue injury of the heel, you must look for clues in the documentation, including the cause of injury as well as patient history. Was there some foreign body lodged in it? Is the patient diabetic? Was she involved in an accident? These answers will help perfect your claim.

Highlight These Common Injury Codes

Does the patient have an open injury? For coding options, you need to search under S90-S99 (Injuries to the ankle, foot and toes). You need to keep in mind that this code range Excludes1: open fracture of ankle, foot and toes (S92.-with 7^th character B).

Does the patient have a wound infection? Typically, you would also need to code any type of wound infection once the organism is known; such as A49.02 (Methicillin resistant Staphylococcus aureus infection, unspecified site); A49.01 (Methicillin susceptible Staphylococcus aureus infection, unspecified site); A49.1 (Streptococcal infection, unspecified site); A49.1 (Streptococcal infection, unspecified site); or A49.8 (Other bacterial infections of unspecified site).

Note: Use secondary code(s) from Chapter 20, External causes of morbidity, to indicate cause of injury. “One of the most common causes would be traumatic injury such as a fall from a height landing on the heels creating tissue and bone bruising or fracture,” says Arnold Beresh, DPM, CPC, CSFAC, of Dr. Arnold Beresh, PLC of Newport News, VA.

Check Out Your Injury Code Options

“There are various types of heel/foot injury codes — injury for blood vessels, contusion, dislocation, fracture, muscle of foot, sprain of heel/foot etc.,” says Apoorba Ganguly CPC, CPMA, Manager of Coding Dept., Medfin Billing Services Pvt. Ltd., Kolkata, India, points out.

Does the patient have a contusion? Currently, if a patient presents with a contusion, you need to answer two questions in order to choose the correct diagnosis code:

1) Is the skin intact?
2) Where is the contusion?

If the skin is intact, you choose a code from any of S90.30XA (Contusion of unspecified foot, initial encounter), S90.31XA (Contusion of right foot, initial encounter) or S90.32XA (Contusion of left foot, initial encounter). The fourth and fifth digits, however, are determined the anatomic site. Depending upon the exact location on the foot, you may decide upon S90.30XA if the injury is on the heels.

For Bruising and Crushing Injuries, Look at These Codes

Does the patient have bruising? Bruises resulting from trauma can occur due to a variety of reasons, including falls, accidents, and post-surgeries. In general, use codes from the S90 (Superficial injury of ankle, foot and toes) family for bruises secondary to trauma.

Note that, as per ICD-10, these codes are for the initial visit only and you should appropriate corresponding codes according to subsequent visits. The above codes exclude contusions that are incidental to specific categories of injuries, such as dislocation and sprain (S93.0-S93.6), fracture (S92.0-S92.9), crushing injury (S97.0-S97.8), nerve injury (S94.0-S90.9), and open wound (S90.1-S90.3).

Did the patient have a crushing injury? Deep tissue injury of the heel is likelier to have been triggered by a crushing injury. If that be so, your coding options are:

• S97.8 — Crushing injury of foot
• S97.80 — Crushing injury of unspecified foot (Crushing injury of foot NOS)
• S97.81 — Crushing injury of right foot
• S97.82 — Crushing injury of left foot

For Foreign Bodies, Investigate Infections

“Foreign bodies creating infection could be the source of deep tissue injury. I have seen a case of a gunshot wound that entered the heel creating massive tissue injury,” says Beresh. In case of a gunshot wound you need to code the underlying cause of morbidity as W34.00 (Accidental discharge from unspecified firearms or gun).

You shouldn’t assume the bullet injury has automatically led to gangrene. “Bullet injury falls under gunshot wound (GSW) ... gangrene or not, that depends on medical conditions ... by default we cannot assume gangrene,” says Ganguly.

In case of gangrene, you need to look under I00-I99 (Diseases of the circulatory system) and I95-I99 (Other and unspecified disorders of the circulatory system). If it isn’t diabetes-related gangrene, your code of choice would be I96 (Gangrene, not elsewhere classified).