While all medical specialties run the risk of being audited, podiatry ranks especially high for audit risk. That puts you on your toes (pun intended!) when submitting claims. Payers want to see your confidence on even the trickiest aspects of coding, which for 2019 includes the revised ICD-10-CM codes for physeal (growth plate) fractures.
There are 17 podiatry/musculoskeletal code changes for 2019—and all but one deals with “unspecified” or Salter-Harris Type 3 physeal fractures. If you’ve got a few key strategies under your belt, you can quickly adapt to these changes, says Lynn Anderanin in her live audio conference with ProfEdOnDemand. During her presentation “ICD-10-CM Coding Updates for Podiatry,” Anderanin shares power tricks to enhance your coding arsenal for the October 1, 2018 start date for 2019 ICD-10 codes.
Podiatry Coding Changes 2019: Identify bone healing & alignment
Let’s take a closer look at the edited codes for 2019:
Revised code Q66.89 addresses “Other specified congenital deformities of feet.”
Code series S99.101 addresses “Unspecified physeal fracture of the right metatarsal”:
- initial encounter for closed fracture (SS99.101A)
- initial encounter for open fracture (S99.101B)
- subsequent encounter for fracture with routine healing (S99.101D)
- subsequent encounter for fracture with delayed healing (S99.101G)
- subsequent encounter for fracture with nonunion (101K)
- subsequent encounter for fracture with malunion (101P)
- sequela (S99.101S)
Code series S99.132 addresses “Salter-Harris Type III physeal fracture of left metatarsal”:
- initial encounter for closed fracture (S99.132A)
- initial encounter for open fracture (S99.132B)
- subsequent encounter for fracture with routine healing (S99.132D)
- subsequent encounter for fracture with delayed healing (S99.132G)
- subsequent encounter for fracture with nonunion (S99.132K)
- subsequent encounter for fracture with malunion (S99.132P)
- sequela (S99.132S)
Important: Check with the physician before using unspecified codes, as there may be some information you missed or that wasn’t initially reported, and usually you should be able to report a specific fracture.
Sharpened Anatomy Tells You Which Code to Select
As you can see, the first thing to know is if the fracture was unspecified or Salter Harris Type III. To know this, you’ll need to know your anatomy pretty well. Here are key terms from the definitions, broken down:
- Physeal fracture: Put most simply, these are growth plate (physis) fractures. Growth plates are found at the ends of long bones (like metatarsals) in children and adolescents.
- Metatarsals: The long, thin bones connecting the phalanges (toes) to the ankle (tarsal) bones.
- Salter Harris Type III fracture: A rare kind of Salter Harris fracture where a force hits both the growth plate and the rounded part of a bone, but doesn’t affect the bone shaft at all. This fracture could involve cartilage, and it could even go into the joint itself.
- Closed v. open fracture: Open fractures involve both a broken bone that protrudes the skin, while a closed fracture is under the skin.
- Nonunion v. malunion: Both deal with how the bone heals. Nonunion is when the bone does not heal as it should, leaving the patient with pain and instability in the area. Malunion, in the case of foot injuries, is when the bone heals in a way that either the foot is deformed or shortened.
Pay Attention: These revised codes are often almost identical, minus a key word or two, to last year’s codes. Double-check your claims before submitting to be confident you picked the right code.
Don’t Get Tripped Up in 2019
Also: ICD-10-CM codes are not just about supporting the very specific foot procedure performed—and getting claims paid. Now, more than ever, if you don’t know your codes inside and out, you won’t paint an accurate picture of patient health, including co-morbidities. And that’s a problem when it comes to Medicare’s risk adjustment procedures under the Merit-Based Incentive Payment System (MIPS).
So start now—before October 1, 2018—to upgrade your know-how with both old-hat codes and podiatry coding updates for 2019, advises Anderanin. You’ll find that a little knowledge goes a long way toward confident coding.
