The primary ICD-10-CM code for a fracture of the foot, excluding the ankle, is S92.
Detailed Explanation of ICD-10-CM Code S92
S92 serves as the overarching category for fractures affecting the foot and toes, specifically excluding those of the ankle joint itself. This code acts as a foundational element in medical documentation and billing, requiring further specific characters to precisely describe the nature and location of the fracture, as well as the patient's encounter type.
The complete ICD-10-CM code for a foot fracture will extend beyond S92 with additional characters that define:
- The specific bone fractured: For example, a metatarsal bone, a tarsal bone, or a phalanx of the toe.
- Laterality: Whether the fracture is on the left foot, right foot, or if the laterality is unspecified.
- The type of encounter: Indicating if it's the initial treatment, a follow-up for healing, or for sequelae (late effects) of the fracture.
For more information on the S92 category and its specific subcodes, you can refer to comprehensive medical coding resources like ICD-10-CM Code S92.
Structure and Specificity of S92 Codes
While S92 is the base, complete ICD-10-CM codes for foot fractures extend with additional characters to provide necessary detail for accurate medical record-keeping and billing.
| Code Series | Description | Required Additional Characters |
|---|---|---|
| S92 | Fracture of foot and toe, except ankle | 4th-6th Character: Specifies the exact bone fractured (e.g., tarsal bone, metatarsal bone, phalanx) and laterality (left, right, unspecified). 7th Character: Indicates the type of encounter (initial, subsequent, sequela). |
Here are some examples of common subcategories under S92, illustrating how the specific bone fractured is identified:
- S92.0-: Fracture of calcaneus (heel bone)
- S92.1-: Fracture of talus
- S92.2-: Fracture of other tarsal bone(s)
- S92.3-: Fracture of metatarsal bone(s)
- S92.4-: Fracture of great toe (phalanx)
- S92.5-: Fracture of other toe(s) (phalanx)
- S92.8-: Other fractures of foot
- S92.9-: Unspecified fracture of foot
The Role of Seventh Characters in Fracture Coding
The seventh character is critical for indicating the stage of healing of the fracture and the specific type of encounter a patient is having for that fracture. This ensures accurate tracking of the patient's treatment progression. Common seventh characters include:
- A: Initial encounter for closed fracture
- B: Initial encounter for open fracture
- D: Subsequent encounter for fracture with routine healing
- G: Subsequent encounter for fracture with delayed healing
- K: Subsequent encounter for fracture with nonunion
- P: Subsequent encounter for fracture with malunion
- S: Sequela (late effects)
Practical Coding Insights
When coding a foot fracture, precision is paramount for proper medical documentation, billing, and statistical analysis.
- Always aim for the highest level of specificity: Ensure the code reflects the exact bone involved, its laterality (left or right foot), and the patient's current stage of treatment for that fracture. For instance, a fracture of the fifth metatarsal on the right foot during an initial encounter would require a code much more detailed than just S92.
- Consider the type of fracture: Although the question specifically refers to "fracture," the seventh character distinguishes between open and closed fractures in initial encounters, which impacts treatment protocols and coding.
- Accurately determine the encounter type: The seventh character ensures that the medical record correctly portrays whether the patient is receiving initial care, follow-up care for healing, or treatment for complications arising from the fracture.
