ICD 10 Coding for Diabetic Foot Ulcers

Foot problems are quite common in people with diabetes. Having too much glucose (sugar) in your blood can result in low blood flow to the affected areas and reduced white blood cell function. Poorly controlled diabetes often results in complications such as foot ulcers. Regarded as the most common reason for hospital stays among people with diabetes, a diabetic foot ulcer (DFU) is an open sore caused by neuropathic (nerve) and vascular (blood vessel) complications of the disease. Typically located on the plantar surface, or bottom/top of toes, pad of foot, or heel of foot, these complex, chronic wounds can affect people with both Type 1 and Type 2 diabetes. If left untreated, diabetic foot ulcers can have a permanent, long-term impact on the morbidity, mortality and quality of a patients’ life. Podiatrists treating diabetic foot ulcers usually collaborate with a team of medical specialists including diabetologist, infectious disease specialist, wound specialist and vascular specialist to treat different types of foot ulcers. As treating non-healing foot ulcers is challenging, podiatric practices can depend on a professional podiatry billing company to simplify their claims processing tasks.

According to the American Podiatric Medical Association (APMA), approximately 15 percent of people with diabetes suffer from foot ulcers. Of those who develop a foot ulcer, about 6 percent will be hospitalized due to serious infections or other ulcer-related complications. The risk of foot ulceration and limb amputations increases with age and duration of diabetes. In the United States, about 82,000 amputations are performed each year on persons with diabetes; half of those ages 65 years or older. Treatment for diabetic foot ulcers varies depending on their causes. The most common risk factors for ulcer formation include – diabetic neuropathy, structural foot deformity, kidney disease, obesity and peripheral arterial occlusive disease. The condition can be effectively prevented if the underlying conditions causing it are diagnosed early and treated correctly.

Types of Diabetic Foot Ulcers

Typically, foot ulcers are defined by the appearance of the ulcer, the ulcer location, and the way the borders and surrounding skin of the ulcer look. There are different types of diabetic foot ulcers –

  • Neuropathic ulcers – occur where there is peripheral diabetic neuropathy, but no ischemia caused by peripheral artery disease. This type of foot infection generally occurs on the plantar aspect of the foot under the metatarsal heads or on the plantar aspects of the toes.
  • Neuroischemic ulcers – occur where the person has both peripheral neuropathy and ischemia resulting from peripheral artery disease. They are often seen on the margins of the foot and also develop on the tips of the toes and beneath any toe nails if these become overly thick.
  • Ischemic ulcers – occur where there is peripheral artery disease present without the involvement of diabetic peripheral neuropathy. Ischemic means reduced blood flow to an area of the body. Poor blood flow causes cells to die and damages tissue. Most ischemic ulcers occur on the feet and legs and these types of wounds can be slow to heal.

Signs and Symptoms

In most cases, diabetic foot ulcers form on the soles of the feet, where skin is subject to constant pressure. Under the weight of the body, skin deteriorates and eventually becomes an open sore. These ulcers frequently form underneath calluses and cannot be felt due to diabetic neuropathy. One of the initial signs of a foot ulcer is drainage from your foot (that might stain your socks or leak out in your shoe). Other related symptoms include –

  • Callused or thickened skin surrounding the ulcer
  • Fever and chills (in advanced stages of foot ulcers)
  • Foul-smelling discharge seeping from the wound
  • Pain and firmness when the wound is touched
  • Swelling, discoloration, and warmth around the wound

Treatment of Chronic Diabetic Foot Ulcer

The goal of treatment is to accelerate the healing process and reduce the chance for infection (or prevent a recurrence of infection). Treatment options generally include –

  • Optimal glucose control – Tight control of blood glucose is crucial for the effective treatment of a diabetic foot ulcer. This will enhance healing and reduce the risk of other complications.
  • Debridement – One of the main ways to treat an ulcer is debridement which involves removing the dead skin and tissue. A podiatrist will clean the wound and cut away all the hyperkeratotic (thickened) skin, infected and nonviable, including necrotic (dead), tissue, slough, foreign debris, and residual material from dressings. This procedure is important because dead skin hampers the development of healthy new tissues, and also makes the affected area more vulnerable to infections. Removal of the dead skin will promote quick and easy healing. Debridement will be done surgically, enzymatically, biologically, or through autolysis.
  • Off-loading – This procedure relieves the pressure from the ulcerated areas. The patient is made to wear special foot gears or other supporting equipment. Pressure from walking can make an infection worse and expand an ulcer. For people who are overweight, extra pressure may be the cause of ongoing foot pain. Inadequate off-loading is a significant reason for the delay of ulcer healing. To reduce the pressure and irritation within the ulcer area and speed up the healing process, podiatrists may recommend wearing special foot gears like diabetic shoes, specialized castings, foot braces, compression wraps, shoe inserts (to prevent corns and calluses), or use a wheelchair or crutches to protect your feet. Half shoes, therapeutic shoes, custom insoles, and the use of felted foam are other alternative methods to off-load wounds located on the forefoot.
  • Dressings – Wounds and ulcers heal faster and have a lower risk of infection if they are kept covered and moist, using dressings and topically-applied medications. As there are different types of diabetic ulcers, podiatrists will apply the most appropriate dressing for the specific type of ulcer. Optimal dressings are free from contaminants, will absorb toxic elements, maintain a moist environment at the wound interface, and protect surrounding healthy skin. Anti-microbial dressings are used for infected diabetic foot ulcers. Daily saline dressings will be used to provide a moist wound environment.
  • Medications – Podiatrists may prescribe antibiotics, antiplatelets, or anti-clotting medications to treat your ulcer if the infection progresses even after preventive or anti-pressure treatments.

Other add-on therapies to treat chronic diabetic ulcers include – hyperbaric oxygen therapy and negative-pressure wound therapy (NPWT). A podiatrist may recommend surgical option if the affected areas of the feet get infected and there is poor blood circulation within those areas. Surgery can help remove pressure on the affected area, (including shaving or excision of bones) and correct deformities, (such as hammertoes, bunions, or bony bumps). Surgery can also help prevent your ulcer from becoming worse or leading to amputation.

ICD-10 Codes for Diabetic Foot Ulcers

Podiatrists conducting assessments and rendering diagnoses of diabetic foot ulcers (DFU) must undergo comprehensive training and have relevant experience in differential diagnosis and the full range of diabetic foot disorders. When documenting DFUs, podiatrists must carefully include the associated symptoms, diagnosis screening tests and treatment procedures performed using the correct medical codes. Outsourced podiatry billing and coding services from a reliable medical billing company can help physicians use the correct codes for their billing purposes. ICD-10 codes for documenting diabetic foot ulcers include –

  • E10.621 – Type 1 diabetes mellitus with foot ulcer
  • E11.621 – Type 2 diabetes mellitus with foot ulcer
  • L97.4 – Non-pressure chronic ulcer of heel and midfoot
    • L97.40 – Non-pressure chronic ulcer of unspecified heel and midfoot
    • L97.41 – Non-pressure chronic ulcer of right heel and midfoot
    • L97.42 – Non-pressure chronic ulcer of left heel and midfoot
  • L97.5 – Non-pressure chronic ulcer of other part of foot
    • L97.50 – Non-pressure chronic ulcer of other part of unspecified foot
    • L97.51 – Non-pressure chronic ulcer of other part of right foot
    • L97.52 – Non-pressure chronic ulcer of other part of left foot
  • L97.8 – Non-pressure chronic ulcer of other part of lower leg
    • L97.80 – Non-pressure chronic ulcer of other part of unspecified lower leg
    • L97.81 – Non-pressure chronic ulcer of other part of right lower leg
    • L97.82 – Non-pressure chronic ulcer of other part of left lower leg
  • L97.9 – Non-pressure chronic ulcer of unspecified part of lower leg
    • L97.90 – Non-pressure chronic ulcer of unspecified part of unspecified lower leg
    • L97.91 -Non-pressure chronic ulcer of unspecified part of right lower leg
    • L97.92 – Non-pressure chronic ulcer of unspecified part of left lower leg

According to the American Podiatric Medical Association, about 14 to 24 percent of Americans with diabetic foot ulcers have amputations. This statistics stresses the importance of good preventive care. Sinceeven a minor injury can lead to foot ulcers in diabetic people, taking adequate preventive measures are crucial. Closely managing the blood glucose levels can help reduce the chances of serious complications.

Foot ulcers are prone to infections, which may become severe. Make sure to take preventive measures such as –

  • Wear properly fitting shoes that have plenty of room in them
  • Keep your legs clean, dry and moisturized
  • Keep toenails adequately trimmed, but not too short
  • Consult a podiatrist for corn and callus removal
  • Check your feet daily for any cuts, blisters or other pre-wound symptoms
  • Change your socks frequently

With all these complexities, the support of an experienced podiatry coding and billing company can be helpful for reporting pressure ulcers correctly for optimal reimbursement. Coders in reliable medical coding outsourcing companies have the knowledge required to ensure accurate reporting of diagnostic details.

How to Streamline Wound Care Prescription Process

Wound dressings serve several important purposes such as absorbing exudates, preventing infection, splinting the wound area and maintaining high humidity. Podiatrists see patients with a wide range of conditions ranging from diabetes to peripheral artery disease that can significantly increase the risk of wounds. Electronic wound care programs are ideal to streamline the wound-care prescription process in any podiatry practice.

Foot and lower-leg wounds require specialized wound care, particularly in patients who are at high risk for complications. Podiatrists know that proper dressing can facilitate faster wound healing in patients. Understanding the purpose of a dressing, the dressing categories, and what makes up a dressing prescription can improve the quality of care podiatrists can provide their patients. Wound dressings can have three layers – primary, secondary, and tertiary and adjuncts (like tape and saline). Primary dressings are typically non-adherents, collagens, or alginates and they are in contact with the wound bed. This dressing might also cover a graft, like a skin graft or a biologic graft. A secondary dressing can be simple gauze, or foam for moderate or heavy drainage and supports the primary dressing. A tertiary dressing is usually a type of wrap, like thin or thick roll gauze, a conforming bandage, a cohesive bandage, or a multilayer compression dressing.

Along with good clinical wound treatment, prescribing the right wound supplies is important for any podiatry practice. Offering wound care kits to patients can ensure that their needs are met, taking your practice to the next level.

Concierge Wound Care Solutions from Hippocratic Solutions

Concierge Wound Care Solutions offered by Hippocratic Solutions is designed specifically to streamline the wound-care prescription process, which benefits podiatrists as well as their patients. The company’s partnership with iRemedy, a leading ecommerce medical supplies provider will enable podiatrists to prescribe, dispense, and bill for advanced wound care supplies through their DME license. Practices can dispense wound care supplies on-time to patients. iRemedy’s online platform makes it convenient for podiatrists to submit and manage wound care prescriptions for their patients with chronic wounds. Podiatry billing process for wound care is also made easy, as this online platform will audit the prescription for the podiatrist and handle insurance preauthorization and any insurance denials. It handles everything right from taking the order to supporting your patient.

With this wound care program, podiatry practices can benefit from a completely streamlined, electronic wound-care prescription process—with no subscription required. This revolutionary program ensures that supplies are put together and shipped directly to the patient’s home in a timely manner.

Digital prescription benefits for podiatrists and patients –

Podiatrists

  • Reduce prescription mistakes and billing errors
  • Earn 100% of revenue generated
  • Improve the quality of patient care
  • Get reimbursement without denials
  • Can do away with physical paperwork
  • Save the amount of time spent on prescription management

Patients

  • Get supplies shipped home directly in a timely manner
  • Avoid trips to the pharmacy or waiting in lines
  • Get wounds treated in the comfort of their own home
  • Save other costs
  • Increased convenience in getting wound supplies
  • Feel the confidence for healing they seek

Digital filing also eliminates going through the long process of waiting for a reply and having to resubmit any necessary changes to be able to fulfill the request. The simple process of digital prescribing frees up time and allows you to put your focus back on the patient.

Digital wound prescription process involves —

  • Signing up for Wound Care Program
  • Submitting patients’ wound care prescriptions online
  • Submitting new orders and reorders as needed

As the patients get their wound care supplies fast, practices can also receive 100% of the revenue generated by wound care orders. Most prescribed wound care products are also billable to insurance. With these Wound Care Solutions, the company also handles claims, insurance verification, wound care package preparation, and shipping. It helps to manage all aspects of supply fulfillment and reimbursement for wound care solutions prescribed by podiatrists for their patients.

Podiatry Billing and Coding – Strategies for Success

Podiatrists may have to deal with diverse foot conditions – chronic or acute. Not all services are reimbursable. Most services related to the foot are based on medical necessity requirements, and this makes podiatry coding and billing rather complex.

Key strategies involved in podiatry billing include:

Insurance verification

Podiatry billing process begins with insurance verification. Most insurance claim denials occur due to lack of verifying insurance benefit information prior to services being provided. Health insurance verification refers to the process of checking a patient’s active coverage with the insurance company and verifying the eligibility of his or her insurance claims. As insurance details can change at any time, even for regular patients, it is important for providers to verify their patient’s insurance eligibility each and every time services are provided.

The most common reasons for denials are – coverage is terminated, the services provided are not covered or maximum benefit for this service has been met. It is critical for podiatry practices to verify all details such as – Payable benefits, Deductibles, Co-pays, Co-insurances, Type of plan and coverage details, Plan exclusions, Patient policy status, Effective date and Insurance name, phone number and claims mailing address.

An experienced podiatry billing company follows certain key strategies in their eligibility verification process such as – patient enrollment, verifying eligibility and benefits, obtaining authorizations, contacting patients and then updating the billing system.

Accurate medical codes and correct modifiers

Accurate medical coding is an important requirement for clean claim submission. More specific ICD-10, CPT and HCPCS codes should be used to report diagnosis and treatment provided to prevent claim denials and ensure appropriate reimbursement. Incorrect coding will impact your practice’s revenue. Certain multiple procedure codes can be listed for one operative note, while some of them may be considered as part of the more complex procedures being performed. Based on specific payer requirements, separate procedure codes can also be billed with other codes. Careful review of all the codes in this range is recommended before choosing the final code for any podiatry procedure. Medical coders should also be up to date with the changing coding standards in podiatry specialty.

Modifiers provide additional information to payers to make sure the provider is paid correctly for services rendered. If appropriate, more than one modifier may be used with a single procedure code; however, they are not applicable for every category of the CPT codes. Some modifiers can only be used with a particular category and some are not compatible with others.

Optimize accounts receivable (A/R)

Accounts receivable (A/R) refer to the money your practice owes. Write-offs of unpaid balances and denied claims after a period of time, without exploring alternative payment options can lead to high A/R. Evaluating A/R is crucial to manage any practice’s revenue cycle and address any issues preventing timely payments.

To optimize A/R management, billing specialists should – have a clear idea regarding how each payer’s specific guidelines affect the practice’s A/R management, know how to establish contact with each payer to help resolve problems faster, analyze reimbursement trends by payers on a monthly basis, file claims on the day of service and implement a strict collections policy for patient accounts. Professional medical billing companies can help practices dramatically reduce their accounts receivable cycle and increase revenue.

Timely appeals of claims

In case of a claim denial, carefully read the explanation of benefits (EOB) and check the remark codes to know why the carrier denied the claim. This will give you the basis for your appeal. While some claims actually need formal appeals, others may require only simple corrections. While appealing, ensure that the correct podiatry form is filled. Consider including the word “appeal” in the title and the text of the document and in any cover letter that is attached with the appeal document. After submitting the appeal, it is important to call and confirm that the insurance company has received the appeal, or review the submission online. Also, follow it up in 30 days.

Collect co-pays

Co-pays make up a large portion of your practice’s revenue. Front office staff must be instructed to collect co-pays upfront from every patient, when they come in for their appointment. This is essential for the success and growth of the practice. Also, have an established financial policy in place. Patients should be made aware of the payments when scheduling appointments; make them sign a form acknowledging that their insurance may not cover all of their care.

Choose a podiatry billing company that is specialized in podiatry, as they will help your practice to deal with all strategies related to billing and coding. They can also deal with claims rejections, billing disputes and other billing issues.

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.

Four Neuropathy Types and What Causes Them

In general, the term ‘neuropathy’ refers to nerve damage or anything that injures or impairs the nerves. Symptoms of neuropathy, which depend on which nerves are affected, include numbness, pain, and balance issues. Based on the type and location of the nerves affected, neuropathy is classified into four types: peripheral, cranial, autonomic and focal. Left untreated, neuropathy can lead to severe pain and serious complications. As it can cause foot problems, peripheral neuropathy is one of the most common conditions podiatrists treat. Outsourced podiatry billing is a feasible option when it comes to efficient claims submission.

Neuropathy can be hereditary or acquired. Let’s take a look into the common types of acquired neuropathy and their causes.

1. Peripheral neuropathy

Peripheral neuropathy refers to nerve damage that impairs muscular movement by affecting the way the body’s nerves send signals to the arms and legs. According to the National Institute of Diabetes and Digestive and Kidney Diseases, about one-third to one-half of people with diabetes has peripheral neuropathy. Diabetic peripheral neuropathy affects the longest nerve fibers first. Depending on the extent of nerve damage, the sensory loss can be only in the toes, extend over the feet, or spread over the lower legs or above the knees.

Factors responsible for acquired peripheral neuropathy include trauma, elevated blood sugar levels, autoimmune diseases, protein abnormalities, certain medications, exposure to toxic chemicals, vascular diseases, vitamin deficiencies, and excessive use of alcohol. Diabetes is the most common systemic disease associated with peripheral neuropathy. The condition can damage the autonomic, motor and sensory nerves. In some cases, the causes of peripheral neuropathy remain unknown even with extensive evaluation, and this condition is known as idiopathic neuropathy.

2. Cranial neuropathy

Cranial neuropathies are caused by damage to one or more cranial nerves or the nerves that arise directly from the brain and affect movement and feeling in the eyes and face. Cranial neuropathies can affect the sensory nerves more than motor nerves. Optic neuropathy affects the eyes, while auditory neuropathy affects hearing. The general symptoms of cranial neuropathy include pain, a tingling sensation, numbness, skin that feels sensitive to the touch, and weak or paralyzed muscles.

There are different types of cranial neuropathies such as Bell’s palsy, microvascular cranial nerve palsy, and third, fourth and sixth nerve palsies. Bell’s palsy causes weakness or partial paralysis of the muscles on one side of the face. Microvascular cranial nerve palsy causes double vision, blurring, drooping eyelids, and pain around the eyes. Multiple cranial neuropathies occur when several nerves are affected.

The causes of cranial neuropathy include: poorly controlled diabetes or high blood pressure, strokes, infections, brain tumors, head trauma, and infections.

3. Autonomic neuropathy (AN)

Autonomic neuropathy refers to damage of the nerves that control involuntary bodily functions. The nerve damage interrupts the messages sent between the brain and other organs. The condition can affect blood pressure, digestion, temperature control, bowel and bladder function, and sexual function.

While many health conditions can lead to this neuropathy type, common causes include diabetes, amyloidosis or abnormal protein build up in organs, alcoholism, and use of certain medications, infectious diseases and degenerative disorders. Older people and those with high blood pressure, high cholesterol and those who are overweight have an increased risk of AN.

4. Focal neuropathy

Less common than peripheral or autonomic neuropathy, focal neuropathy involves damage to single nerves, usually in the head, torso, or leg. The condition can cause muscle weakness or pain. Entrapments are the most common type of focal neuropathy, and occur when nerves become compressed or trapped in narrow passages between bones and tissues. Carpal tunnel syndrome is the most common entrapment neuropathy.

Typical symptoms of focal neuropathy include double vision, eye pain, paralysis on one side of the face, severe pain areas such as the lower back or leg(s), and chest or belly pain that is sometimes mistaken for heart attack or appendicitis. The major causes of focal neuropathy are high blood sugar levels, and high levels of fats, such as triglycerides in the blood.

ICD-10 Codes for Neuropathy

Diagnostic strategies for neuropathy include physical exam, medical history, neurological examination, and blood tests, imaging and nerve function tests, and nerve and skin biopsies. Here are some ICD-10 codes related to neuropathy that physicians can use to report the condition:

  • G62.0 Drug-induced polyneuropathy
  • G62.1 Alcoholic polyneuropathy
  • G62.2 Polyneuropathy due to other toxic agents
  • G62.9 Polyneuropathy, unspecified
  • G90.09 Other idiopathic peripheral autonomic neuropathy
  • E11.40 Type 2 diabetes mellitus with diabetic neuropathy, unspecified
  • E11.41 Type 2 diabetes mellitus with diabetic mononeuropathy
  • E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy
  • E11.43 Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy
  • E11.49 Type 2 diabetes mellitus with other diabetic neurological complication
  • E13.4 Other specified diabetes mellitus with neurological complications
  • E13.40 Other specified diabetes mellitus with diabetic neuropathy, unspecified
  • E13.41 Other specified diabetes mellitus with diabetic mononeuropathy
  • E13.42 Other specified diabetes mellitus with diabetic polyneuropathy
  • E13.43 Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy
  • E13.44 Other specified diabetes mellitus with diabetic amyotrophy
  • E13.49 Other specified diabetes mellitus with other diabetic neurological complication

Treatment of neuropathy is focused on relieving pain and other symptoms by addressing the underlying causes of the condition, such as diabetes or infections. Treatment modalities include medications and various therapies such as vitamin therapy, transcutaneous electrical nerve stimulation (TENS), physical therapy, orthotics, and so on. Treatment options recommended would depend on the type of nerve damage, symptoms, and location.

A basic understanding of nervous system is crucial for coders to determine which codes represent the documented conditions. Partnering with a podiatry billing company will help podiatrists submit their timely and accurate claims for optimal reimbursement.

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