Podiatry ICD-10 coding: The basics you need to know to be useful straight out of residency for billing!!!

So you have just graduated from your podiatry residency, or you are wanting to seem more marketable after you are done your PSR-36.   Remember, everyone you are competing against has completed a PSR-36 residency!! How do you make yourself stand a part from the rest?  If you want to make yourself more marketable, know something about the codes that will make you money seeing and treating patients.  Your future partner, or associate in a group, is a part of a business and you need to have an understanding of the ICD-10 codes in order to make money for them and yourself. Since October 2015, when the shift to ICD-10 took place we implemented our new ICD-10 Superbill or Encounter form. We have been extremely successful and continuing to treat patients and bill without having any interruption of payment for services. As we are approaching the one year anniversary of using this form we wanted to offer a reference form, at a small cost to you, to help you acclimate to the business/doctor world out of the ivory tower of academia.    As a podiatrist, you know you have to be a little more scrappy than the other specialties.  We know modifiers, as we have the craziest modifiers and are a modifier specialty in our procedure codes.  So you should not fear the new diagnosis codes that are followed by: A D G S for the trauma fracture codes for example.

After one week of billing you will remember easily that when seeing fractures these letters will trail your diagnosis:

• A, Initial encounter for closed fracture
• B, Initial encounter for open fracture
• D, Subsequent encounter for fracture with routine healing
• G, Subsequent encounter for fracture with delayed healing

I struggled in the beginning to the level of specificity that is truly needed for your claim to be considered clean in the shift from ICD-9 to ICD-10.  I can tell you, if you bill 73630 for example, for x-rays right side for a right foot 2nd metatarsal fracture non-displaced, the exact code is S92.324A.  There is also a code of S92.301A that is fracture of metatarsal closed right foot that would most likely get this claimed covered for you as well. On my superbill I did not included every fracture of every bone.  My recommendation is to have a cheat sheet for fractures of metatarsals laminated and put in your office and at every desk in your office where staff members sit. We have this cheat sheet available and included with our Podiatry specific ICD-10 Superbill.  This is available at our website at:http://centeranklefootcare.com/icd-10.html

But at the end of the day, what you need to make sure you know how to bill inside and out is your most common diagnosis with your most common procedures.  Sure I see trauma, but I see a lot of plantar fasciitis, posterior tibial tendonitis, peroneal tendonitis, ankle sprains, ulcers and diabetic foot care.  I will tell you that these are clear and very straightforward for the most part in ICD10. We are all in this together and should not be overwhelmed by the bean counters. 

 In my own practice, I can tell you that my world did not come crumbling down when the ICD-10 codes took over, 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 in the beginning were my diabetic foot ulcers.  After a short time we worked out the kinks and 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. 

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.  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.

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