Learn How to Report a Sever’s Disease Diagnosis
Question: A pediatric patient presented to the podiatry clinic with complaints of pain in both heels. The podiatrist collected a history and performed a physical examination. The patient’s parents attested that the child plays soccer for nine months of the year. The provider then ordered X-rays of the heel to check for fractures, which were negative. After reviewing the patient’s injury and history, the physician diagnosed the child with Sever’s disease. What code will I assign to report the diagnosis? Kentucky Subscriber Answer: You’ll assign M92.61 (Juvenile osteochondrosis of tarsus, right ankle) and M92.62 (Juvenile osteochondrosis of tarsus, left ankle) to report the diagnosis. Sever’s disease, also known as calcaneal apophysitis, is an injury that occurs from repetitive strain on the patient’s heel. It is a common cause of heel pain in children. The condition consists of inflammation in the growth plate of the heel bone. Children’s bones are softer at the ends where the bones are growing, which makes them more susceptible to injury. When you search for Sever’s disease in the ICD-10-CM code book Alphabetic Index, you’ll be redirected to Osteochondrosis, juvenile, tarsus, which provides you with M92.6- (Juvenile osteochondrosis of tarsus) to verify in the Tabular List. In the Tabular List, you’ll discover that you need a 5th character to identify the laterality of the injury — “1” to indicate the right ankle and “2” to indicate the left ankle. Note: You’ll also arrive at the M92.6- code subcategory by searching the Alphabetic Index for Apophysitis, calcaneus. Mike Shaughnessy, BA, CPC, Production Editor, AAPC
