David J. Freedman, DPM, FASPS, CPC, CSFAC, CPMA

David J. Freedman, DPM,
FASPS, CPC, CSFAC, CPMA
● Certified Professional coder
● Certified Surgical Foot & Ankle Coder
● Certified Professional Medical Auditor
● www.ICDTENHELP.com
● APMA Coding Committee, member
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since 2005
ICD 10 Team Manager APMA
Past President, Maryland Board of
Podiatric Medical Examiners
Past Chairperson, 9th and 10th
Annual National APMA CAC PIAC
meeting
CAC member Maryland
Maryland Podiatric Medical
Association Coding Tips.
26 years of Coding Experience
ICD-10 – MPMA ICD-10-CM
Disclosure Information
I or a related party have a financial relationship with a
financially interested entity within the past/next 12
months:
ICDtenhelp.com
© Copyright 2014 by Dr. David J. Freedman
DPM PA all rights reserved.
Today’s Schedule Continued
10:15 am – 12:15 pm
Mapping)
why you can’t
coding
“GEMs-General Equivalency
and cross walks from ICD9,
rely on these for all the
conversions”
12:15 – 1:15 pm Lunch Break
1:15 – 2:45 pm
Private Practice clinical examples
2:45 – 3:15 pm
break
3:15 – 5:00 pm
Private Practice clinical examples
continued and Q&A.
© Copyright 2014 by Dr. David J. Freedman DPM PA all rights
reserved.
GEMs-General Equivalency
Mapping and cross walks from
ICD9, why you can’t rely on these
for all the coding conversions
• Where can I find these?
• My software uses these so what?
https://www.cms.gov/Medicare/Coding/ICD10/2014-ICD10-CM-and-GEMs.html
Index Issues that showed up in 2011
“sinus tarsi syndrome” referred to “Tarsal Tunnel
Syndrome” (G57.50), a neurological disorder.
These are wholly separate – factually,
anatomically, and diagnostically – syndromes.
At minimum in ICD-10, the index should direct
to code M25.57-, to be accurate in ICD-10 “Joint
Pain, Foot”
• 2014 Index M25.57-
Index Issues that showed up in 2011
Shin splints in the ICD-10 Index takes you to T79.6
(traumatic ischemia of muscle). GEM maps shin splints to
S86.911A (strain of unspecified muscle(s) and tendon(s)
at lower leg level, right leg, initial encounter) and
S86.912A (strain of unspecified muscle(s) and tendon(s)
at lower leg level, left leg, initial encounter).
Recommendation to WHO/CDC: Shin splints are not
clinically ischemia of muscle. Shin splints are
characterized by inflammation of the periosteum of the
tibial and of the anterior and medial muscles of the lower
leg. M60.86- (other myositis, lower leg) offers an option
and possibility of a more correct code from the existing
set of codes.
2014 Index is S86.89-Other injury of other muscles and
tendons at lower leg level
Index Issues that showed up in 2011
Complex Regional Pain Syndrome (CRPS) and Reflex
Sympathetic Dystrophy (RSD), were not easily found in the
ICD-10 Index.
In 2014 Index
- complex regional pain —see Syndrome, pain, complex
regional
- CRPS I —see Syndrome, pain, complex regional I
- reflex (sympathetic) —see Syndrome, pain, complex
regional I
Tabular 2014
G90.5- Complex regional pain syndrome I (CRPS I)
Reflex sympathetic dystrophy
G57.7- Complex regional pain syndrome II of lower limb
Index Issues that showed up in 2011
“Sesamoiditis” when referenced in the ICD-10
Index directs to the reader to see
“Osteomyelitis”. This was not correct.
Sesamoiditis is an inflammatory condition, not a
bone infection (osteomyelitis).
Suggest indexing to: M25.871, M25.872 and
M25.879 Other specified joint disorder, ankle
and foot.
2014 Index - Sesamoiditis M25.8-
Index Issues that showed up in 2011
ICD-9 754.50 (congenital talipes varus) is indexed
with ICD-9 754.51(congenital talipes equinovarus)
in ICD-10. Both are indexed in ICD-10 to Q66.0
(congenital talipes equinovarus). Congenital talipes
varus should index to Q66.1 (congenital talipes
calcaneovarus).
2014 Index-Talipes (congenital) Q66.89
- equinovarus Q66.0
-varus Q66.3
2014 Tabular Q66.3- Other congenital varus
deformities of feet
Index Issues that showed up in 2011
ICD-9 754.53 (congenital metatarsus adductus) is
Indexed to Q66.2. Metatarsus adductus is
adduction of all the metatarsals not just the first
metatarsal (metatarsus primus varus). Congenital
metatarsus adductus could Index to Q66.3 (other
congenital varus deformities of feet).
2014 Index-Metatarsus, metatarsal —see also
condition - varus (adductus) (congenital) Q66.2
2014 Tabular-Q66.2 Congenital metatarsus (primus)
varus
Index Issues that showed up in 2011
The common diagnosis of “bunion” found in
ICD-9 is not present in ICD-10. Bunion is
mapped to M20.10 (hallux valgus).
2014 Index-Bunion —see Deformity, toe, hallux
valgus
- - hallux valgus M20.12014 Tabular- M20.1 Hallux valgus (acquired)
Bunion
https://www.cms.gov/Medicare/Coding/ICD10/2014-ICD10-CM-and-GEMs.html
Besides the CMS tools a very effective
tool is found at the AAPC web site
It is important to see more typical
podiatric examples regarding mapping
and potential issues if you rely strictly
on mapping
My conclusion about index? It gets you close but
not the actual code rule never code from index
My conclusion about mapping? It gets you close
but not the actual code a fair amount of the time!!!
https://www.aapc.co
m/ICD-10/icd-10mapping.aspx
• Session Objectives For the remaining part today:
• Learn typical ICD-10 coding scenarios for foot
conditions
• Learn typical ICD-10 coding scenarios for ankle
conditions
• Learn typical ICD-10 coding scenarios for lower
leg conditions
• Discuss payer LCDs and ICD-10 coding as it relates
to foot and ankle conditions.
ICD-10 coding scenarios for foot conditions
• Patient presents
to the foot and
ankle specialist
but there are no
feet or ankles?
• So what to do?
We are done, let’s
go have lunch!
Documentation-starts with a Patient Record
Let’s Start with Charting
• Example #1
Diabetic At Risk Foot Care
“Initial” Encounter
In ICD-10-CM
• There are many types of Diabetes, it is critical
you know their type of diabetes.
• So, let’s go over the many options
ICD-9 to ICD 10 Coding
1) Type 2 DM with neuropathy. ICD9=250.60 and 357.2
1) E11.42 Type 2 diabetes mellitus with
diabetic polyneuropathy
ICD-9 to ICD 10 Coding
2) Type 2 DM with peripheral vascular disease 250.70
2) E11.51 Type 2 diabetes mellitus with
diabetic peripheral angiopathy without
gangrene
ICD-9 to ICD 10 Coding
3) Onychomycosis ICD9=110.1
3) B35.1 Onychomycosis
ICD-9 to ICD 10 Coding
4) Onychauxis ICD9=703.8
4) L60.3 Nail Dystrophy
ICD-9 to ICD 10 Coding
5) Corn and Callus ICD9=700
5) L84 Corn/Callus
In Summary based on ICD-10 Rules the
following are coded:
1) E11.51 Type 2 diabetes mellitus with diabetic peripheral
angiopathy without gangrene
2) E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy
3) B35.1 Onychomycosis
4) L60.3 Nail Dystrophy
5) L84 Corn/Callus
So what if the patient has PVD?
In Summary based on ICD-10 Rules to
meet “At Risk Foot Care”
the following are coded:
1) I73.9 Other peripheral vascular diseases, unspecified
OR
2a) I70.201-Unspecified Atherosclerosis of native arteries of
extremities, right leg
2b) I70.202-Unspecified Atherosclerosis of native arteries of
extremities, left leg
2c) I70.203-Unspecified atherosclerosis of native arteries of
extremities, bilateral legs
3) B35.1 Onychomycosis
4) L60.3 Nail Dystrophy
5) L84 Corn/Callus
Just to throw another twist on the PVD
Front, what if……..?
There is claudication
1a) I70.211- Atherosclerosis of native arteries of extremities with
intermittent claudication, right leg
1b) I70.212- Atherosclerosis of native arteries of extremities with
intermittent claudication, left leg
1c) I70.213- Atherosclerosis of native arteries of extremities with
intermittent claudication, bilateral legs
Just to throw another twist on the PVD
Front, what if…….?
There is rest pain
1a) I70.221- Atherosclerosis of native arteries of extremities with
rest pain, right leg
1b) I70.222- Atherosclerosis of native arteries of extremities with
rest pain, left leg
1c) I70.223- Atherosclerosis of native arteries of extremities with
rest pain, bilateral legs
Integumentary Examination
Documentation
• Incurvated medial left hallux nail border.
• Inflamed, erythematous, purulence, and pain
medial nail border left hallux.
Ingrown Nail 703.0
Rest of Today’s Schedule
12:15 – 1:15 pm
Lunch Break
1:15 – 2:45 pm
Private Practice clinical
examples
2:45 – 3:15 pm
break
3:15 – 5:00 pm
Private Practice clinical
examples continued and
Q&A.
© Copyright 2014 by Dr. David J. Freedman DPM PA all rights
reserved.
Questions?
Email: [email protected]

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