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Find out what condition feels like stepping on a pebble.

Between sports, playing, and growing, children鈥檚 feet are prone to a number of conditions that can affect their day-to-day activities. Some conditions are acquired while others are congenital (present at birth), and as a podiatry coder, you鈥檒l want to familiarize yourself with each one.

Learn about five well-known conditions affecting pediatric patients鈥� feet and refresh your coding knowledge.

Let Your Pigeon Toe Coding Take Flight

Intoeing, commonly known as pigeon toes, is a condition that often affects the feet of young patients, including babies. The toes point inward instead of forward when the patient鈥檚 feet are walking, running, standing, or resting. While the condition is normal in infants, it isn鈥檛 considered a birth defect since it usually resolves itself on its own.

Intoeing is congenital when the condition is present from birth. When you search the ICD-10-CM Alphabetic Index for Pigeon > toe, you鈥檙e redirected to Deformity > toe. The next indentation, congenital, provides you with Q66.9- (Congenital deformity of feet, unspecified) to verify in the Tabular List.

Each code in the Q66.9- subcategory requires a 5^th character to indicate the laterality. Assign Q66.91 (Congenital deformity of feet, unspecified, right foot) for intoeing of the right foot. Use Q66.92 (Congenital deformity of feet, unspecified, left foot) for a left foot intoeing diagnosis. You鈥檒l assign Q66.90 (Congenital deformity of feet, unspecified, unspecified foot) when the podiatrist doesn鈥檛 specify which foot is affected.

Remember the 7^th Character for Sprains

Ligaments connect bones to one another, and a sprain is a type of injury to a ligament. When the ligament is overly stretched or possibly torn, a sprain can occur. Children are more prone to fractures due to their growth plates being weaker than muscles or tendons. However, when pediatric patients experience a sprain, it is most likely an ankle sprain.

The ankle joint features three ligaments that can be injured:

• Anterior talofibular ligament
• Posterior talofibular ligament
• Calcaneofibular ligament

You鈥檒l assign one of the codes in the S93.41- (Sprain of calcaneofibular ligament) code subcategory for an ankle calcaneofibular ligament sprain. The 6^th characters 鈥�1鈥� and 鈥�2鈥� indicate laterality, while 鈥�9鈥� is reserved for an unspecified ankle.

• S93.411- (Sprain of calcaneofibular ligament of right ankle)
• S93.412- (Sprain of calcaneofibular ligament of left ankle)
• S93.419- (Sprain of calcaneofibular ligament of unspecified ankle)

For anterior talofibular ligament and posterior talofibular ligament sprains, you鈥檒l assign an applicable code from the S93.49- (Sprain of other ligament of ankle) code subcategory. This code features 鈥淪prain of talofibular ligament鈥� as an additional condition term. Again, the 6^th characters 鈥�1,鈥� 鈥�2,鈥� and 鈥�9鈥� specify the right ankle, left ankle, or unspecified ankle, respectively.

7^th character required: Parent code S93.- (Dislocation and sprain of joints and ligaments at ankle, foot and toe level) instructs you to append one of the following 7^th characters to the end of the codes mentioned above to complete each diagnosis code:

• A 鈥� Initial encounter
• D 鈥� Subsequent encounter
• S 鈥� Sequela

Find the Correct Codes for Congenital Flat Feet

Flat feet is a condition that affects the patient鈥檚 foot arches. The condition occurs when the arches of the patient鈥檚 feet collapse, and the entire soles contact the ground. Another term for flat foot is pes planus, which means fallen arches.

Patients can experience flexible, rigid, congenital, or acquired flat foot conditions. The most common type of flat foot is flexible flat foot, which happens when the arches appear when the patient isn鈥檛 standing, but disappear when the patient stands up. When the patient鈥檚 arches are nonexistent regardless of whether the patient is sitting or standing, they have rigid flat feet.

Congenital flat feet are present from birth and occur due to abnormalities in the foot鈥檚 structure. Codes for congenital flat feet are found in the Q66.5- (Congenital pes planus) code subcategory.

The codes for congenital flat feet are:

• Q66.50 (Congenital pes planus, unspecified foot)
• Q66.51 (鈥� right foot)
• Q66.52 (鈥� left foot)

Code Q66.5- also features 鈥渃ongenital rigid flat foot鈥� as an additional term in the event the patient was born with a rigid flat foot condition.

Additional codes may be used to describe any associated conditions or complications.

Patients develop acquired flat feet over time and the condition is typically caused by other factors, such as arthritis, tendon dysfunction, or injury. You鈥檒l look to the M21.4- (Flat foot [pes planus] (acquired)) code subcategory to report an acquired flat foot diagnosis:

• M21.40 (Flat foot [pes planus] (acquired), unspecified foot)
• M21.41 (鈥� right foot)
• M21.42 (鈥� left foot)

Identify the Ingrown Toenail Code

An ingrown toenail occurs when the sides of the nail grow into the skin and tissue on the sides of the nail. As the nail cuts into the skin, the patient is at risk of developing inflammation and infection.

In the ICD-10-CM code book, turn to the Alphabetic Index, and look for Ingrowing > nail (finger) (toe). You鈥檒l then verify L60.0 (Ingrowing nail) in the Tabular List.

Pinpoint the Wart Diagnosis Code

Children and teenagers can develop warts on the soles of their feet. Caused by viruses in the human papillomavirus (HPV) family, warts are easily passed 鈥� especially when patients walk barefoot in public spaces, such as locker rooms, swimming pools, and gym showers. Warts on the soles of the feet are near the plantar fascia tissue, which is why they are commonly called plantar warts.

Assign B07.0 (Plantar wart) when a provider diagnoses a patient with a plantar wart. The patient may feel like they鈥檙e stepping on a pebble as they walk, and the pain can worsen as the wart grows deeper into the foot.

Mike Shaughnessy, BA, CPC, Development Editor, AAPC