Three Painful Foot and Ankle Injuries and Their ICD-10 Codes

Foot and ankle injuries usually occur during sport participation, but can also occur when the foot or ankle is forced into an awkward position when walking or performing other everyday activities. Achilles tendon rupture, ankle fracture, and Lisfranc injury are three types of painful foot and ankle injuries that medical coding service providers help physicians report to payers. Applying the right ICD-10 codes based on the documentation is critical to create and submit claims for appropriate reimbursement.

Achilles Tendon Rupture

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An acute rupture of the Achilles tendon is amongst the common tendon injuries in the US adults. Symptoms include a feeling of a sudden snap at the back of the leg, intense pain and swelling near the heel, and inability to climb stairs, run, or stand on the toes. However, as patients can present without any signs or symptoms, cases may be initially misdiagnosed. The Thompson test which involves squeezing the calf with the patient prone and the knee on the affected side flexed can help diagnose the condition. Pulses and sensation in the foot may be also checked. X-rays, ultrasound, and MRI may be used if the diagnosis remains uncertain after the physical examination.

The ICD-10 codes for Achilles tendon rupture are:

M76.6 Achilles tendinitis

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

There are two options for the management of Achilles tendon rupture: surgical repair and nonoperative treatment which involves referral to a functional rehabilitation program. Surgery may be the better alternative as it will reduce the risk of repeat rupture. Nevertheless, treatment recommended will depend on the patient’s condition, underlying medical concerns if any, the extent of the injury and the future activity expectations.

Ankle Fracture

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The ankle joint, the region where the leg and foot meet, consists of three articulations: the talocrural joint, the tibiofibular joint, and the subtalar joint. The ankle joint allows the upward and downward movement of the foot. An ankle fracture involves one or more bones in the joint and is an extremely painful condition. Appropriate diagnosis and timely intervention are necessary to prevent long-term complications and debility.

Typical symptoms of a broken ankle include difficulty or inability to support weight, tenderness or pain, swelling which increases with the severity of the swelling, and discoloration of the skin which is usually due to bruising.

Ankle fractures have symptoms similar to sprains. X-rays can identify a broken bone or bones and distinguish the injury from a sprain, which is a soft-tissue injury. A CT scan or MRI may be needed to determine the full extent of the injury.

Diagnosis of ankle fracture is reported using the following ICD-10 codes:

S82.84 Bimalleolar fracture of lower leg

• S82.841 – Displaced bimalleolar fracture of right lower leg
• S82.842 – Displaced bimalleolar fracture of left lower leg
• S82.843 – Displaced bimalleolar fracture of unspecified lower leg
• S82.844 – Nondisplaced bimalleolar fracture of right lower leg
• S82.845 – Nondisplaced bimalleolar fracture of left lower leg
• S82.846 – Nondisplaced bimalleolar fracture of unspecified lower leg
• S82.851 – Displaced trimalleolar fracture of right lower leg
• S82.852 – Displaced trimalleolar fracture of left lower leg
• S82.853 – Displaced trimalleolar fracture of unspecified lower leg
• S82.854 – Nondisplaced trimalleolar fracture of right lower leg
• S82.855 – Nondisplaced trimalleolar fracture of left lower leg
• S82.856 – Nondisplaced trimalleolar fracture of unspecified lower leg

The Weber ankle fracture classification categorizes the injury into three types, A, B and C, based on the level of the fracture. Ankle stabilization bracing without immobilization is used to manage Type A fractures. Six weeks of immobilization in a walking boot is recommended for nondisplaced type B and C fractures, which need to be followed up closely until bony union is achieved. Surgery may be required to if the bone does not align properly after 3 months.

Lisfranc injury

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The Lisfranc joint is the point at which the metatarsal bones and the tarsal bones connect. Lisfranc injury consists of a variety of midfoot injuries in which one or more metatarsals are displaced from the tarsus. Lisfranc injuries include sprains, fractures and dislocations, which can sometimes occur simultaneously.

Lisfranc injury is typically caused by a direct blow to the midfoot which can occur in high energy motor vehicle accidents (MVA), industrial accidents, crush injury, falls from heights, and sports participation. Lisfranc injury is difficult to identify and diagnosis is missed on initial assessment in 20% of cases, according to an MDedge article.

Symptoms may include swelling of the foot, pain in the midfoot when standing or when pressure is applied, inability to bear weight, bruising or blistering on the arch or/and top of the foot, and abnormal widening of the foot.

Lisfranc injuries can be confused with ankle sprains. In addition to a physical exam, X-rays and other imaging studies may be performed to understand the extent of the injury and arrive at the diagnosis.

The ICD-10 codes for LisFranc injury are:

• S93.324 – Dislocation of tarsometatarsal joint of right foot,
• S93.325 – Dislocation of tarsometatarsal joint of left foot
• S93.326 – Dislocation of tarsometatarsal joint of unspecified foot

Management of Lisfranc injury depends on the stability of the joint complex and severity of the injury. Stable injury without fracture can be managed with immobilization in cast for two weeks and use of crutches to avoid putting pressure on the injured foot. If tenderness improves this can be followed by weight-bearing as tolerated in the boot. If pressure builds up within the tissues of the foot, a complication of Lisfranc injury, it can damage the nerves, blood vessels and muscles in the foot. In this case, surgery would be required to prevent tissue damage.

There are specific ICD-10 codes to report foot and ankle injuries. Outsourced medical billing services provided by experienced companies can help physicians assign the correct codes and submit accurate claims for optimal reimbursement.

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