Wiki Flat Foot - Congenital vs Acquired -

[nolanspade]

My provider is treating a dancer who has pes planovalgus. She coded as acquired, but I queried her because her documentation does not state a cause for acquired flat foot.

She does not state in her documentation acquired or congenital, and she does not document "this is what caused the flat foot" (like arthritis due to dancing or something.)

I do not see a rubric for "code x if not specified" so I'm at a loss. Any suggestions? I've already inquired, and she says "It is unknown if he was born with flatfeet, without having his pediatric evaluation."

My thinking is to default to congenital unless we know a cause, but maybe I'm wrong? Please help!

 

[sls314]

My provider is treating a dancer who has pes planovalgus. She coded as acquired, but I queried her because her documentation does not state a cause for acquired flat foot.

She does not state in her documentation acquired or congenital, and she does not document "this is what caused the flat foot" (like arthritis due to dancing or something.)

I do not see a rubric for "code x if not specified" so I'm at a loss. Any suggestions? I've already inquired, and she says "It is unknown if he was born with flatfeet, without having his pediatric evaluation."

My thinking is to default to congenital unless we know a cause, but maybe I'm wrong? Please help!

The alphabetic index for pes planus directs you to "Deformity, limb, flat foot" takes you to M21.4- and the word acquired is in parentheses. That means that "acquired" is an optional term to use the code.

The Excludes1 note lists congenital pes planus Q66.5- however your documentation doesn't specifically say that it was congenital. If it's not documented as such, I would not use the Q66.5- code. You can only go where the alphabetic index takes you, which seems to be the M21.4-

 

[nolanspade]

The alphabetic index for pes planus directs you to "Deformity, limb, flat foot" takes you to M21.4- and the word acquired is in parentheses. That means that "acquired" is an optional term to use the code.

The Excludes1 note lists congenital pes planus Q66.5- however your documentation doesn't specifically say that it was congenital. If it's not documented as such, I would not use the Q66.5- code. You can only go where the alphabetic index takes you, which seems to be the M21.4-

Awesome - thanks for your quick reply. I work as an auditor also, and I'm wondering where it says that parenthetical entries are optional--I just read all the front pages of ICD10 other than the guidelines and did not see anything indicating same. I really appreciate your help, and I don't mean to pick apart your answer. I just don't want to tell this provider her code was right or wrong and score her accordingly without being able to back it up fully. Thanks again!

 

[sls314]

Awesome - thanks for your quick reply. I work as an auditor also, and I'm wondering where it says that parenthetical entries are optional--I just read all the front pages of ICD10 other than the guidelines and did not see anything indicating same. I really appreciate your help, and I don't mean to pick apart your answer. I just don't want to tell this provider her code was right or wrong and score her accordingly without being able to back it up fully. Thanks again!

It's in the ICD-10-CM guidelines.

Section 1, A, 7 Punctuation:

( ) Parentheses are used in both the Alphabetic Index and Tabular List to enclose supplementary words that may be present or absent in the statement of a disease or procedure without affecting the code number to which it is assigned. The terms within the parentheses are referred to as nonessential modifiers. The nonessential modifiers in the Alphabetic Index to Diseases apply to subterms following a main term except when a nonessential modifier and a subentry are mutually exclusive, the subentry takes precedence. For example, in the ICD-10-CM Alphabetic Index under the main term Enteritis, “acute” is a nonessential modifier and “chronic” is a subentry. In this case, the nonessential modifier “acute” does not apply to the subentry “chronic”.