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   http://centeranklefootcare.com/catalog/c14_p1.html
this is an editable rtf and pdf format.

Good luck with your billing!

Michele McGowan, DPM

More importantly, why you shouldn't waste too much time or money on ICD-10 minutia!

The answer to why you should not waste too much time or effort on the minutia codes of ICD-10 has a lot to do with how great most EMR's are with the codes.  I was playing around with my EMR as I was seeing an ankle sprain in my office today for an initial visit and this is what I got in a split second after clicking on the diagnosis of ankle sprain:

I have to say, if your EMR is not doing this for you with such ease, you may have more difficulty than it is worth navigating through the ICD-10 changes.

Yes, you should have quick reference for your most common diagnosis and procedures for podiatry.  But don't get lost in all the codes, if your EMR is up to snuff the codes will be there for you when someone walks in with a displaced talar neck fracture.

I recommend playing around with your EMR and making sure it is already set to do this for you, and if not you need to find out why.  This is a process that your EMR should be ready for well before October 1st, 2015.

http://centeranklefootcare.com/catalog/c14_p1.html

Billing Ingrown Nail under the new ICD-10 Codes

It seems as though the ingrown toenail codes that are billable to the highest level of specificity  right now are for the right and left great toenails.  I guess this is not that big of a deal, considering most of the ingrown toenails are usually the big toenails.  The old code for ingrown toenail was 703.0 is now L60.0 there is no laterality with this code but I would use this code with the other ones suggested next.  The old code for paronychia or infected ingrown nail was 681.11.  The new ICD-10 code has laterality but only for the great toes.  Right great toe infected ingrown toe nail is L03.031 and left is L03.032.  So if you are billing a 11730 or a 11750 the modifier for the toe should still be used on the CPT code.

Billing 11730 or 11750

Use the following codes:
L60.0- Ingrown Nail
L03.031- if right hallux  modifier on CPT code T5
L03.032- if left hallux    modifier on CPT code TA
M79.609 which is just pain in limb this is the unspecified pain in limb because there is no pain in limb in foot or toes specific.

This is pretty straightforward information, so far as it looks in the new world of ICD-10.  Again, in our practice, this is a procedure that we perform several times throughout the day.  I suggest knowing what you do every day inside out.  The more common things should be well established in your mind before October 1st, 2015 so this transition is smooth for you.  If you have a good EMR you will be able to look up the specific code translation from ICD9 to ICD10, and there are so many nice resources available on the web for your reference for the "zebras" that walk into your office.  Remember, know your codes for plantar fasciitis/heel pain, diabetic foot care, ingrown nails, and the other most common patients you see a day.  There is a lot of transparency in what we do, but in a good way.  Many people come to us for very simple problems and we have simple answers to help them in usually a very cost effective way.

Michele McGowan, DPM
The Center for Ankle and Foot Care
http://centeranklefootcare.com/catalog/c14_p1.html

Plantar fasciitis and ICD10 coding, what do you need to know?

This is an easy one, you just need to know the new ICD-10 code from the old ICD-9 code.  The plantar fasciitis, much to my surprise, does not have laterality.  So the old plantar fasciitis ICD-9 code was 728.71 and now is M72.2.

I'm guessing that when ICD-11 hits this will change, but for now it is a pretty simple and straightforward conversion.

So a new patient with right foot plantar fasciitis would look like this:

ICD-10 Diagnosis codes:
M72.2       Plantar fasciitis
M79.604   Pain in limb right limb
M77.31     Heel spur right calcaneus(if on x-ray there is a spur and you dictate it, I would recommend this code as well.)  Being as specific as possible is going to be very important in ICD-10. The M77.31 specifies laterally for right side and the code for left heel spur is M77.32.

CPT procedure codes for this patient would be:
99203       If you have documented well and spent the appropriate amount of time with the patient you have a new patient encounter of this level.
73630 R   If you are taking X-rays in office to rule out stress fracture or evaluate possible heel spur, this is the 3 views of the foot with the appropriate right sided modifier.  But this is where we see our laterally with plantar fasciitis in the x-rays.

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 ton of plantar fasciitis, 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 at http://centeranklefootcare.com/catalog/c14_p1.html
this is an editable rtf and pdf format.

Good luck with your billing!

Michele McGowan, DPM

If you are a podiatrist, you treat diabetic feet......It's what you do! Know the ICD-10 codes you need to know for treating your diabetic patients.

 •Many people getting lost in the trauma coding but unless you are in a very high trauma practice, these should not be your main focus.

•Don’t get distracted by the coders who can’t pronounce calcaneus•Know your most common procedures and know how to code them

At risk foot care•Billing 11721•You need to document your class finds and have your Q modifiers correct•Diagnosis needed:•Must have diabetes diagnosis•Choices:•E11.40 DM2 Neuro Comp•E11.51 DM2 PVD Comp•E10.40 DM1 Neuro Comp•E10.51 DM1 PVD Comp•Must have Nail pathology
•B35.1 Mycotic Nail•If Neuro Modifier being used the DM diagnosis had it but would consider using G60.9 which is peripheral Neuropath

   Mycotic diabetic foot care for DM type 2 with neuro might look like

•Procedure code: 11721 Q8•Diagnosis codes:
•E11.40•B35.1•G60.9•Procedure Codes: 11055,11056 Q8•Diagnosis codes:
•E11.40•B35.1•G60.9•L84

Mycotic diabetic foot care for DM type 2 with neuro might look like

    Procedure code: 11721 Q

    •Diagnosis codes:

•E11.51
•B35.1
•I73.9
•Procedure Codes: 11055,11056 Q9
•Diagnosis codes:
•E11.51
•B35.1
•I73.9
•L84
Mycotic diabetic foot care for DMtype1 with neuro might look like
•Procedure code: 11721 Q8
•Diagnosis codes:
•E10.40
•B35.1
•G60.9
•Procedure Codes: 11055,11056 Q8
•Diagnosis codes:
•E10.40
•B35.1
•G60.9
•L84
Mycotic diabetic foot care for DM type1 with PVD might look like
•Procedure code: 11721 Q9
•Diagnosis codes:
•E10.51
•B35.1
•I73.9
•Procedure Codes: 11055,11056 Q9
•Diagnosis codes:
•E10.51
•B35.1
•I73.9
•L84
•If you are a practicing podiatrist seeing diabetic patients can decrease the possibility of them having a non traumatic amputation tremendously
•In the study by Weck, et al, in Cardiovascular Diabetology, 2013. Instituting a structured diabetic foot program can yield a 75% reduction in amputation rates and a near four-fold reduction in inpatient mortality.
•It has been proven time and time again in peer reviewed literature, that these patients who have diabetes that visit the podiatrist are much less likely to have an amputation of an extremity. 
• Podiatric medical care in people with history of diabetic foot ulcers can reduce the high level amputation between 65% and 80%. Gibson, et al, Int Wound Journal 2013. 
Ulcer diagnosis in diabetics
•If your patient is Type 1 diabetic with an ulcer the diagnosis code is:  E10.622
•If your patient is Type 2 diabetic with an ulcer the diagnosis code is: E11.622
•These codes are the highest level of specificity for the types of Diabetic Ulcers we see in the office (do not confuse with pressure ulcers, different codes)
•This is a good improvement, as all of the ulcer codes used to be jumbled together whether they were pressure, diabetic ect.
•Coding for Diabetic Foot Ulcer debridement
•11042, 11043 and 11042 use modifier L or R
•There is no laterally in the diabetic ulcer codes themselves so laterally is still in your procedure codes
•Diagnosis: 
•E11.621 Type 2 dm with foot/ankle ulcer
•E10.622 Type 1 dm with foot/ankle ulcer
•To be specific as possible I would consider also coding their diabetes
•Choices:
•E11.40 DM2 Neuro Comp
•E11.51 DM2 PVD Comp
•E10.40 DM1 Neuro Comp
•E10.51 DM1 PVD Comp
•Yes they have diabetes and an ulcer. But documenting the DM2 Neuro E11.40, for example, is letting them know that the diagnosis of ulcer is “due to” the Neuro Complications
•This makes this much more specific

Check out our website at: http://centeranklefootcare.com/catalog/c14_p1.html for a superbill for podiatry most common codes