1. Documentation and ICD-10 Coding
Jeffrey D. Lehrman, DPM, FASPS, MAPWCA
APMA Coding Committee
Expert Panelist, Codingline
APMA MACRA Task Force
Fellow, American Academy of Podiatric Practice Management
Board of Directors, ASPS
Board of Directors, APWCA
Twitter: @DrLehrman
October 1, 2015
forgiveness

2. DFU Coding
Type 2 diabetic patient with a chronic diabetic left lateral midfoot ulcer with necrosis of muscle. The patient takes insulin on a daily basis.

4. L97.423
Non-pressure chronic ulcer of left heel and midfoot with necrosis of muscle

8. E11.621
Type 2 diabetes mellitus with foot ulcer

11. DFU Coding
Type 2 diabetic patient with chronic diabetic left foot lateral midfoot ulcer with necrosis of muscle. The patient takes insulin on a daily basis.
• E Type 2 diabetes mellitus with left foot ulcer
• Z Long term (current) use of insulin
• L Non-pressure chronic ulcer of left heel and midfoot with necrosis of muscle

12. DFU Documentation ICD 9 Chronic Midfoot ulcer in Type 2 diabetic
Chronic, non-pressure left midfoot ulcer with necrosis of muscle in a type 2 diabetic with long term insulin use

13. ICD 9 vs. ICD 10
Initial encounter for a closed, nondisplaced, Left 2nd toe proximal phalanx fracture
ICD 9: : Closed fracture of phalanx of foot
ICD 9 documentation:
X-ray shows fracture of phalanx
Fracture, phalanx, closed

18. ICD 9 vs. ICD 10
Initial encounter for a closed, nondisplaced, Left 2nd toe proximal phalanx fracture
ICD 10: S92.515A (nondisplaced fracture of proximal phalanx of left lesser toe(s), initial encounter for closed fracture
Documentation:
Closed, nondisplaced left 2nd toe proximal phalanx fracture

19. ICD 9 vs. ICD 10 ICD 9 Fracture, phalanx, closed ICD 10
Closed, nondisplaced left 2nd toe proximal phalanx fracture

20. • Non-fracture care • Fracture care
• A – initial encounter
• D – subsequent encounter
• S – sequela
• Fracture care
A – initial encounter for closed fracture
B – initial encounter for open fracture
D – subsequent encounter for normal healing fracture
G – subsequent encounter for delayed healing fracture
K – subsequent encounter for fracture with non-union
P – subsequent encounter for fracture with mal-union
S – sequela of fracture •

21. Sequela • Generally 2 codes need to be used in the following order:
• The condition or nature of the sequela is coded first.
• Then the sequela code (what caused it) is second.

22. Sequela of Prior Ankle Sprain
• Chronic left ankle instability following Grade III sprain
of the calcaneofibular ligament six months prior.
ICD – 9: – Ligamentous Laxity, Ankle

25. M24.272

29. Sequela of Prior Ankle Sprain ICD-10
• M : Disorder of ligament, left ankle
• S93.412S : Sprain of calcaneofibular ligament of the left ankle, sequela

30. Ligamentous Laxity Documentation
ICD 9
Assessment:
Ligamentous Laxity, Ankle
ICD 10
Assessment:
Ligamentous laxity, left ankle as a result of a calcaneofibular ligament sprain

31. Thank You!!

32. Documentation and ICD-10 Coding
Jeffrey D. Lehrman, DPM, FASPS, MAPWCA
APMA Coding Committee
Expert Panelist, Codingline
APMA MACRA Task Force
Fellow, American Academy of Podiatric Practice Management
Board of Directors, ASPS
Board of Directors, APWCA
Twitter: @DrLehrman
October 1, 2015
forgiveness

33. Resources
Fife, C.E., MD, FAAFP, CWS. The debridement dilemma returns,
National Government Services. National Government Services LCD for Debridement Services (L27373),
Just Coding News. (August 8, 2012). Differentiate between types of wound debridement. JustCoding News: Outpatient
Novitas Local Coverage Determination (LCD): Wound Care (L35139)

34. Resources
Kesselman, P., DPM. (September, 2013). Wound care billing update, Podiatry Management pg 53-59
LeGrand, M., RN, MA CCS-P, CPC., Changes in reporting wound débridement,
CGS Medicare. (May 9, 2012). Documenting surgical debridement services – Measurements matter
Noridian Medicare, Wound care and debridement – Provided by physician, NPP or as incident-to services,