Reports suggest that about 75% of the people in the United States suffer from foot problems at some time in their lives. Regarded as one of the most complex parts of the body, the foot is made up of 26 bones connected by many joints, muscles, tendons, and ligaments. The feet are prone to different types of injuries and malfunctions, causing pain and restricting mobility. The causes of foot problems can range from medical conditions and sport-related injuries to ill-fitted shoes. The feet are susceptible to infections caused by viruses, bacteria, and fungi. Systemic illnesses like diabetes can also affect and change the feet, which can limit daily activity and quality of life. Whatever the cause, foot concerns should not be ignored and warrant medical attention. Podiatrists are specialized in diagnosing and treating conditions and function of the foot and ankle. Podiatry coding and billing can be challenging as the procedures and services related to the foot are very specific due to the medical necessity requirements and restrictions on the type of conditions that can be treated. Medical billing outsourcing can help physicians submit accurate claims for appropriate reimbursement.
Let’s take a look at five common foot concerns that podiatrists treat and their related ICD-10 codes.
Plantar fasciitis – Plantar fasciitis causes stabbing heel pain that usually occurs with your first steps in the morning. This foot problem is common among people who engage in sports like football or baseball that involve running, which puts repeated stress on the foot. The condition involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects the heel bone to the toes (plantar fascia). People who are overweight and those who wear shoes with inadequate support have an increased risk of planter fasciitis.
Podiatrists generally recommend conservative treatment modalities to address heel pain associated with plantar fasciitis. This includes medications (pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), steroid injections, resting and icing the painful area. Physical therapy exercises can help ease the pain and inflammation. Patients may be advised to wear night splints and custom-fitted arch supports (orthotics) to distribute pressure across the affected foot more evenly. Wearing proper shoes and avoiding activities that put additional strain on the foot may help prevent the condition in the long run. Key ICD-10 codes for plantar fasciitis include:
- M72 – Fibroblastic disorders
- M72.0 – Palmar fascial fibromatosis [Dupuytren]
- M72.1 – Knuckle pads
- M72.2 – Plantar fascial fibromatosis
- M72.4 – Pseudosarcomatous fibromatosis
- M72.6 – Necrotizing fasciitis
- M72.8 – Other fibroblastic disorders
- M72.9 – Fibroblastic disorder, unspecified
Bunions – A bunion is a bony bump that forms on inside of the foot at the joint of the big toe. Also called “Hallux Valgus”, this bone deformity develops when the bone of the big toe excessively angles or pushes against the next toe (instead of straight ahead), forcing the joints to get bigger and protrude. Causes of this progressive bone disorder include an inherited structural defect, stress on the foot or a medical condition, such as arthritis. If left untreated, this bone defect will gradually increase and make it extremely painful to wear shoes or even walk properly. Most people do not experience any specific symptoms during the early stages of bunion formation. Symptoms generally become visible while wearing certain types of footwear like shoes with a tight toe box or high-heeled shoes. Common symptoms include – persistent pain, swelling, redness, numbness or soreness around the big toe joint, hardened skin under the foot, and corns or calluses.
Treatment options for this bone deformity vary depending on the severity of the bumpy growth and the amount of pain it causes. Medications like acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) and cortisone injections can help relieve pain and swelling. Lifestyle adaptations like choosing appropriate fitting footwear, shoe inserts/orthotics, Padding, taping, or splinting of the toe and applying ice to the affected area will reduce soreness and inflammation. Surgery will be considered only if the bone disorder interferes with the patient’s daily activities or causes frequent pain and inflammation that does not improve with other treatments.
Diagnosis is reported using the following ICD-10 codes:
- M20.1 – Hallux valgus (acquired)
- M20.10 – Hallux valgus (acquired), unspecified foot
- M20.11 – Hallux valgus (acquired), right foot
- M20.12 – Hallux valgus (acquired), left foot
Ingrown toenails – Ingrown toenails occur when the toenail starts to grow in to the nail groove, causing significant pain and discomfort. Wearing shoes and socks that don’t fit properly can push the skin into the nail plate. Other causes include – toenails that are not trimmed properly, such as cutting the toenails too short or trauma to the feet due to activity including running. In addition, having a family history of ingrown toenails can also increase a person’s risk. Symptoms include redness, swelling, pain, and drainage from the toenail.
Treating and preventing ingrown toenails requires patients to follow a systematic foot care routine. Prevention strategies include – wearing properly fitting shoes (that do not have a pointy tip), washing the feet with antibacterial soap, keeping the feet clean and dry, cutting the toe nails straight across after a bath when the nails are soft and avoiding cutting the nails in a rounded pattern (as this can increase the risk of inward growth). If the toenail is infected or at-home care does not improve the condition, patients need to consult a podiatrist. To treat the condition, the podiatrist may need to remove a portion of the toenail. Antibiotics will be prescribed to treat the infection. The ICD-10 code this foot condition is:
- L60.0 – Ingrowing nail
Athlete’s Foot – A fungal infection that generally begins between the toes, athlete’s foot is common among people whose feet become very sweaty while confined within tight fitting shoes. Also called tinea pedis, the condition is caused by the growth of the contagious tinea fungus on the feet. If left untreated, it can spread to the toenails and the hands. Symptoms of athlete’s foot include – itching, stinging, and burning (between the toes or on soles of feet), blisters on the feet, cracking and peeling skin and discolored, and thick, crumbly toenails.
Podiatrists generally recommend over-the-counter (OTC) topical antifungal medications to address this foot infection. Patients would also be advised to soak their feet in salt water or diluted vinegar to help dry up blisters. Adopting self-care measures like – washing feet with soap and water every day, applying anti-fungal powders, wearing socks made out of breathable fibers, keeping the feet dry and changing socks when the feet get sweaty can help prevent athlete’s foot infections. The ICD-10 code used for athlete’s soot is:
- B35.3 – Tinea pedis
Corns and calluses – Corns and calluses are thick, hardened layers of skin that develop on the feet when your skin tries to protect itself against friction and pressure. Corns and calluses can make a person feel as if they are walking on stones. The condition is common among people who wear ill-fitting shoes, have sweaty feet, and those who stand for long periods each day. While corns generally form on the toes, calluses develop on the soles of the feet, especially under the heels or balls, on the palms of the hands, and also on the knees. Symptoms include: a bump on the skin; thick, hardened skin; flaky, dry and waxy skin, and pain or tenderness in the affected area.
To prevent corns from forming, podiatrists recommend – wearing shoes that give the toes plenty of room and using protective coverings (like felt pads, non-medicated corn pads or bandages) over areas that rub against footwear. Patients with diabetes who have corns or calluses should wear extra-depth shoes or diabetic shoes with offloading insoles.
If a corn or calluse continues to become painful despite following certain self-care measures, it is important to consult a foot doctor or podiatrist. Treatment may involve cutting or removing some of the hard skin with a scalpel to relieve pressure on the tissues that lies beneath. Related ICD-10 code include –
- L84 – Corns and callosities
Foot care plays a vital role in maintaining your overall health. By giving your foot some well-deserved attention, you can make your feet look younger, stronger and keep it pain-free. Preventing the incidence of foot problems requires having a clear understanding about the causes, symptoms, risk factors about the associated condition and the steps to be taken to avoid them in the long run. A combination of medications, non-surgical modalities and self-care measures usually work to relieve acute foot pain. Chronic conditions will need more aggressive treatment.
Treating patients with different foot problems and managing their documentation requirements can be quite taxing for podiatrists. When it comes to ensuring appropriate care as well as reporting services for maximum reimbursement, podiatric practices can stay top of the game by outsourcing these tasks to reliable podiatry billing company. An experienced service provider will have a team of expert coders who stay updated with the current, changing coding rules and payer guidelines and work with physicians to ensure proper claim filing and reimbursement.