Coding Foot and Ankle Injuries in ICD-10

Foot and ankle injuries are very common in sporting and everyday situations. Of all the sports-related injuries, foot and ankle problems are the top issues that make millions of Americans visit their local podiatrists each year. As per reports, foot and ankle injuries account for more than 3 million emergency department visits annually in the United States (2017 statistics). Regarded as a complex structure in the body, the foot and ankle balance and support the weight of the body while providing complete mobility. The risk of injury is higher among physically active individuals who engage in repetitive motions or sports activities like – basketball, soccer, hockey, football and cricket that require frequent running, jumping or quick direction change. Podiatrists along with other specialists work together to develop a comprehensive treatment plan for managing chronic symptoms associated with different types of foot injuries. Podiatry coding and billing can be challenging as there are several rules related to reporting these complex foot procedures. Outsourcing medical billing services to an experienced service provider can help podiatrists submit accurate claims for appropriate reimbursement.

Generally, an ankle or foot sprain occurs when the ligaments in the foot or ankle are partially or completely torn. Common symptoms include – severe pain, swelling, stiffness, tenderness or bruising in the affected areas. In some cases, people also experience serious difficulty while standing or walking for a long time. The type and severity of pain experienced in the foot or ankle may be minor, but may also be chronic that could be a major symptom of a more serious condition that requires treatment. Treating and preventing different types of foot and ankle injuries involves a combination of proper warm-up and conditioning, application of a brace, splint, or cast and other pain management techniques.

Let’s take a look at the common types of foot and ankle injuries, their causes, and treatment options along with the diagnosis codes –

Achilles Tendinitis – Achilles Tendinitis is caused by repetitive or intense strain on the Achilles tendon – the band of tissue that connects your calf muscles to your heel bone. Regarded as an overuse injury, this condition is common among runners who have suddenly increased the intensity or duration of their activity. It can also occur in middle-aged people who play sports such as tennis or basketball. Pain symptoms usually begin as a mild ache in the back of the leg or above the heel. Mild cases of this condition can be easily treated with simple, self-care measures. Taking over-the-counter medications (such as ibuprofen (Advil, Motrin IB, others) or naproxen), doing physical therapy exercises and wearing orthotic devices can help relieve strain on the tendon and reduce pain. However, severe cases involving tendon tears (ruptures) may require surgical repair.

Key ICD-10 codes for Achilles tendinitis include –

• M76.6 Achilles tendinitis
• M76.60 Achilles tendinitis, unspecified leg
• M76.61 Achilles tendinitis, right leg
• M76.62 Achilles tendinitis, left leg

Shin splints – Shin splints occur due to an inflammation of the muscles, tendons, and bone tissue around your tibia (the large bone in the front of your lower leg). Also known as Medial/Anterior tibial stress syndrome, the condition often occurs in athletes who have recently intensified or changed their training routines. Tenderness, soreness or pain along the inner side of your shinbone and mild swelling in your lower leg are the common symptoms.

Diagnosis of this condition begins with a physical exam and medical history evaluation. X-rays or other imaging studies can help identify other related causes for your pain, such as a stress fracture. Initial treatment modalities for this injury condition include rest, ice, medications and other self-care measures. Patients need to avoid activities that cause pain, swelling or discomfort. Applying ice packs to the affected shin for 15 to 20 minutes at a time (four to eight times a day) for several days can help protect skin and prevent swelling. Consuming over-the-counter pain relievers like ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) or acetaminophen (Tylenol, others) may help reduce pain. In addition, wearing the right type of footwear and modifying your exercise routine can help prevent shin splints from recurring. For reimbursement purposes use these ICD-10 codes –

• M76.81 Anterior tibial syndrome
• M76.811 Anterior tibial syndrome, right leg
• M76.812 Anterior tibial syndrome, left leg
• M76.819 Anterior tibial syndrome, unspecified leg

Ankle sprain – An ankle sprain is an injury to the tough bands of tissue (ligaments) that surround and connect the bones of the leg to the foot. This injury occurs when you accidentally roll, twist or turn your ankle in an awkward way. This can stretch or tear the tough bands of tissue (ligaments) that help hold your ankle bones together. In most cases, sprained ankles involve injuries to the ligaments on the outer side of the ankle. These injuries can occur due to several causes like – a fall that causes your ankle to twist, landing awkwardly on your foot after jumping or pivoting, walking or exercising on an uneven surface and another person stepping or landing on your foot during a sports activity.

Symptoms of a sprained ankle generally include – pain, swelling, tenderness, bruising, inability to put weight on the affected ankle and skin discoloration. Treatment modalities comprise home-care measures (like wearing braces, wrapping the ankle with ACE bandage, using crutches, applying Ice packs and keeping your ankle elevated) and taking medications (such as ibuprofen (such as Advil) or acetaminophen (such as Tylenol) to manage pain. Once the swelling and pain reduces, physicians will recommend doing physical therapy exercises to restore your ankle’s range of motion, strength and flexibility. ICD-10 codes include –

• S93.4 Sprain of ankle
• S93.40 Sprain of unspecified ligament of ankle
• S93.401 Sprain of unspecified ligament of right ankle
  • S93.401A Sprain of unspecified ligament of right ankle, initial encounter
  • S93.401D Sprain of unspecified ligament of right ankle, subsequent encounter
  • S93.401S Sprain of unspecified ligament of right ankle, sequela
• S93.402 Sprain of unspecified ligament of left ankle
  • S93.402A Sprain of unspecified ligament of left ankle, initial encounter
  • S93.402D Sprain of unspecified ligament of left ankle, subsequent encounter
  • S93.402S Sprain of unspecified ligament of left ankle, sequela
• S93.409 Sprain of unspecified ligament of unspecified ankle
  • S93.409A Sprain of unspecified ligament of unspecified ankle, initial encounter
  • S93.409D Sprain of unspecified ligament of unspecified ankle, subsequent encounter
  • S93.409S Sprain of unspecified ligament of unspecified ankle, sequela

Plantar fasciitis – One of the most common causes of heel pain, plantar fasciitis involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia). The condition causes stabbing heel pain that usually occurs with your first steps in the morning. It is more common among runners. In addition, people who are overweight and those who wear shoes with inadequate support have an increased risk of suffering this condition.

Most people who suffer from plantar fasciitis tend to recover with conservative treatments, including medication, resting, icing the painful area, and stretching. Doing physical therapy exercises can help ease the pain and inflammation. Wearing night splints and custom-fitted arch supports (orthotics) may help distribute pressure to your feet more evenly. Avoiding activities that put additional strain on the foot and wearing correct fitting shoes may help prevent the condition in the long run. Related ICD-10 codes 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

Hammertoe – Hammertoe is an abnormal bend in the middle joint of a toe. This condition causes your toe to bend or curl downward instead of pointing forward. Although this foot deformity can affect any toe, it most commonly affects the second or third one. The type of shoes you wear, foot structure, traumatic toe injury, arthritis, an unusually high foot arch can all contribute to this foot condition. Typical symptoms include – a toe that bends downward, inability to flex your foot or wiggle your toes, difficulty walking, corns or calluses and claw-like toes.

In most cases, a hammertoe can be effectively treated by wearing properly fitting shoes. If a high arch is causing the condition, wearing toe pads or insoles in your shoes can help. These pads work by shifting your toe’s position, which in turn corrects the appearance of your toe and alleviates pain. However, if the toe condition is becoming painful or causing the toes to become deformed, podiatrists will surgically reposition the toe and restore movement. ICD-10 codes for toe deformity include –

• M20.4 Other hammer toe(s) (acquired)
  • M20.40 Other hammer toe(s) (acquired), unspecified foot
  • M20.41 Other hammer toe(s) (acquired), right foot
  • M20.42 Other hammer toe(s) (acquired), left foot

Stress fractures – Stress fractures are tiny cracks in a bone caused by repetitive force, often from overuse like repeatedly jumping up and down or running long distance. The condition can also occur from normal use of a bone that’s weakened by a condition such as osteoporosis. These types of fractures are more common in the weight-bearing bones of the lower leg and foot. Patients may not experience any pain during the initial days of the fracture. However, as the condition progresses, there will be tenderness and swelling in a specific spot which reduces with adequate rest. Wearing a walking boot or brace or using crutches can help reduce the symptoms of the condition. ICD-10 codes used for stress fractures include –

• M84.37 Stress fracture, ankle, foot and toes
  • M84.371 Stress fracture, right ankle
  • M84.372 Stress fracture, left ankle
  • M84.373 Stress fracture, unspecified ankle
  • M84.374 Stress fracture, right foot
  • M84.375 Stress fracture, left foot
  • M84.376 Stress fracture, unspecified foot
  • M84.377 Stress fracture, right toe(s)
  • M84.378 Stress fracture, left toe(s)
  • M84.379 Stress fracture, unspecified toe(s)
• M84.38 Stress fracture, other site

As the feet and ankles are subject to high performance in a variety of sports, they are easily susceptible to different types of injuries. Maintaining good balance, flexibility and strength can help avoid these injuries from happening. Prevention of different types of foot and ankle injuries begins with a combination of proper warm-up, conditioning and careful attention to technique. Podiatrists and other foot pathology specialists may suggest a combination of non-surgical modalities and self-care measures to reduce the occurrence of these injuries.

While these foot and ankle injuries differ in types, recovery time for these may also depend on the type and severity of injury. Taking proper rest and avoiding activities that may put additional stress on the injured area are vital for recovery. Wrapping the injured area with a bandage, or using a brace are good alternatives to provide consistent compression to the injured area and stabilize the joint. Wearing the correct athletic shoes with the proper fit can also help in this regard.

Podiatrists need to be knowledgeable about the highly specific ICD-10 codes to report the common foot and ankle injuries. Podiatry billing services provided by an experienced service provider can help physicians in this specialty submit accurate claims for optimal reimbursement. Make sure that the coders are well-versed with the codes relating to the diagnosis and treatment of foot and ankle injuries and their related complications.