Friday, December 11, 2015

ICD-10 Coding for Diabetic wounds, what you as a podiatrist should know.

We are now a 2 full months into the ICD-10 code take over.  In my own practice, I can tell you that my world did not come crumbling down, and claims from all payers are coming in the normal standard fashion.  All of my at risk foot care or diabetic foot care claims have all been clean with no problems. Normal every day tendon injuries like peroneal tendonitis, Achilles tendonitis, posterior tibial tendonitis and plantar fasciitis claims are going through as well with no problems.

The only claims that I had kicked back to me have been my diabetic foot ulcers.  The following is what you need to know to bill a diabetic foot wound correctly:

1.  You will need the diabetic foot code associated with if the person is Type 1 or Type 2 diabetic and has a foot wound

  • E11.621- Type 2 diabetes with foot ulcer
  • E10.621- Type 1 diabetes with foot ulcer
2.  You will need the code for the specificity of the site, laterality, and depth.  L97.5 is a non pressure wound other part of the foot(toes) and L97.4 is a non pressure wound on the heel or midfoot adding a 1 or 2 gives the laterality, right or left foot respectively. But the addition of depth is included in the codes below to give you the most specificity for these codes to be covered and paid. 

If your wound is on the right side you will be using one of the codes below for a diabetic foot wound on the toes:
  • L97.511-  Right foot non pressure ulcer with breakdown of skin
  • L97.512-  Right foot non pressure ulcer with fat layer exposed
  • L97.513-  Right foot non pressure ulcer with necrosis of muscle
  • L97.514-  Right foot non pressure ulcer with necrosis of bone

If your wound is on the left side you will be using one of the codes below for a diabetic foot wound on the toes:
  • L97.521-  Left foot non pressure ulcer with breakdown of skin
  • L97.522-  Left foot non pressure ulcer with fat layer exposed
  • L97.523-  Left foot non pressure ulcer with necrosis of muscle
  • L97.524-  Left foot non pressure ulcer with necrosis of bone
If your wound is on the right side you will be using one of the codes below for a diabetic foot wound on the heel or midfoot:
  • L97.411-  Right foot non pressure ulcer with breakdown of skin
  • L97.412-  Right foot non pressure ulcer with fat layer exposed
  • L97.413-  Right foot non pressure ulcer with necrosis of muscle
  • L97.414-  Right foot non pressure ulcer with necrosis of bone
If your wound is on the left side you will be using one of the codes below for a diabetic foot wound on the heel or midfoot:
  • L97.421-  Left foot non pressure ulcer with breakdown of skin
  • L97.422-  Left foot non pressure ulcer with fat layer exposed
  • L97.423-  Left foot non pressure ulcer with necrosis of muscle
  • L97.424-  Left foot non pressure ulcer with necrosis of bone
3.  Most of our diabetic patients that have foot ulcers also have some degree of polyneuropathy and coding for that would get you to the highest level of specificity using one of the following codes linking the Type 1 or 2 diabetes with the polyneuropathy:

  • E11.42- Type 2 diabetes with diabetic polyneuropathy
  • E10.42- Type 1 diabetes with diabetic polyneuropathy
For example, from the information above, if you had a Type 2 diabetic with a foot ulcer on their left heel with exposed bone and they have polyneuropathy the only three codes you need to be reimbursed with the correct documentation, would be the following:
  • E11.621
  • L97.424
  • E11.42
This again is pretty simple when you have it all in front of you and organized, As it is almost impossible to have all of these codes on your superbill or encounter form, it may be a great idea to have these codes on a cheat sheet in each treatment room.  It will save you time, not having to scroll through your EMR for the codes, especially of you see high volume of diabetic wounds. 

I hope this helps makes your life a little easier in the ICD-10 new world of billing. I know in my practice I see a lot of diabetic wounds so I was happy to see these codes were not terribly convoluted. If you do not have a "superbill" we have a quick reference sheet, for what we see as podiatrist most common diagnosis, available at our website. For $75 we will email it to you with our metatarsal fracture cheat sheet and our power point on billing diabetic foot care. Our website is listed here
this is an editable rtf and pdf format.

Good luck with your billing!

Michele McGowan, DPM

Saturday, December 5, 2015

Ingrown toenail, we can fix it so it never bothers you again at the Center for Ankle and Foot Care!!!

Ingrown toenail keeping you from really enjoying this Holiday Season?   Limping while looking for that ultimate Christmas gift for a loved one due to a painful toenail?  This does not have to happen!  At our office, The Center for Ankle and Foot Care, in Clermont Florida, we can fix that the same day. Like the video above says, Dr. McGowan and Dr. Henne are available daily and can get you in quickly to help you with whatever your foot or ankle problem may be.

Read on a little more to see if what you have is an ingrown nail.  If your symptoms sound familiar to below it would be wise to get in to see Dr. McGowan or Dr. Henne so you can continue to look for your gifts for friends and family without the pain!

People describe the pain as severe at times, and even describe difficulty sleeping due to the lightest touch like that of their sheet. Below are commonly described symptoms with an ingrown nail.
   The following symptoms may be present with ingrown toenails:
  • Pain
  • Redness and swelling
  • Drainage
  • Odor
  • Prominent skin tissue (proud flesh)
At the Center for Ankle and Foot Care, just like in podiatrist offices across the country, we have a simple in office procedure that literally only takes minutes to correct your  problem forever! (Unless you start to wear bad shoes or have trauma to the area!) 

Don't wait until it gets too bad to get in.  On the right you can see we only take a small portion of the nail. We put a medicine under the skin so the offending border of nail no longer grows.  In most cases you can barely tell you even had this simple in office procedure performed! Once the nail is ingrown there are not too many things you can do for yourself at home to make this better.  Call your foot doctor and get in right away!

If you would like more information about our office or our doctors visit our website at

Thursday, December 3, 2015

Running with plantar fasciitis, you can get better and keep running!

Plantar fasciitis or heel pain is a real bugger to have for anyone, but when you are a runner it is 1,000
times worse.  I speak from experience.  This summer I began to run 4-5 times a week and increased my mileage to about 4 miles a run after a month or two.  Running is one of my favorite activities to do now, other than playing with my children and hanging out with my husband!  A year ago I would have never said those words about running.

After the second month of running, it happened, I got out of bed one morning and felt the very familiar stabbing pain on the bottom of my foot, known as plantar fasciitis.  I couldn't believe that I, a podiatrist, would get what so many of my patients come in to have treated. The good news was I immediately knew what I had and I started to treat myself. Below I have wrote my steps down for other runners who may be experiencing the same problem and would like some simple advice.  My one disclaimer is, if you do not know if you have plantar fasciitis, I would recommend seeing a foot doctor before you start a treatment program. There is a small possibility of a stress fracture in the heel bone

It is also important to note, that from August until November, I experienced some symptoms on and off of the heel pain.  I continued to run and on some occasions increased my mileage.  The running , I believe was not the source of aggravation of my plantar fasciitis, the resting after running and lack of stretching were the biggest culprits!

Step 1: Stretch
Your calf muscle is a big powerful muscle group of the lower extremity.  This is also a muscle group that does the majority of work when you are running below the knee.  This muscle group plays a huge role in pro pulsing you forward with each step while you are running.  These muscles need extra attention or they will let you know they are not happy with you.  I have included the perfectly illustrated stretching exercises you should be doing before and after running and maybe two other times a day.  Also, purchasing a night splint is a nice way to get  static extended stretch while you are resting, watching TV or sleeping.   Another great tool for a deeper stretch is using a Pro-stretch.
Step 2: Ice
Icing is really important to help calm down plantar fasciitis, especially when you are continuing to run.  I always say get a 20oz bottle of water and freeze it.  Roll it under your foot for 10 minutes 2 or three times a day.  Giving you a deep stretch and ice it a great natural anti-inflammatory. This is quick, easy & very worth it for the plantar fascia. Other devices are sold kit that can help you get a deep stretch and freeze a foam roller in a Thera-band kit.      
Step 3: No Barefoot and Good shoes
Going barefoot when you have plantar fasciitis is a killer.  I always tell patient they have to have something on your feet while you are walking around even in the house.  A great alternative is a spenco flip flop.  They have a little bit of a built in support in the arch.  Sneakers really are the gold standard to help you get better, as long as they are in good condition.  Sometimes you have to ditch your dress shoes for 4-6 weeks to give good supportive care. Many sneaker have built in support in the arch too. Asics are one of my favorite running shoes for support in the arch.  Just remember that the more miles you put on  a week the quicker you will need to replace your shoe, no matter how great they are, probably every 3-5 months.  Running 3-5 miles 4 times a week I replaced my sneakers after 2 months.  If you have new shoes and just feel like you need more support I would recommend superfeet, spenco or power step over the counter inserts. If you were to go see a podiatrist, they would most likely recommend one of these over the counter inserts.

If you are a runner and have plantar fasciitis, running is usually fine to continue but remember to STRETCH, ICE, & GOOD SUPPORT are the keys to keep you running and help you get better!