Diagnosing and Documenting Charcot’s Foot – An Overview

by | Published on Feb 3, 2020 | Medical Coding

Documenting Charcot's Foot
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Foot problems are a major health concern and a common cause of hospitalization among diabetic people. Generally, diabetic people experience different complications of the disease which include – nerve damage and poor blood circulation. One of the more critical foot problems caused by nerve damage is Charcot’s foot – a condition that attacks the bones, joints, and soft tissue in your feet. Also called Charcot Arthropathy, the condition can deform the shape of the foot and lead to disability. The condition can result from complete or near-complete numbness in one or both feet or ankles. It causes the bones in the foot to become weak, making them more prone to damage such as fractures and dislocation. If not detected in its earliest stages, the joints in the foot collapse and the foot eventually becomes deformed. A deformed foot can cause pressure sores to develop in the foot or ankle. An open wound with foot deformity can lead to an infection and even amputation. The symptoms of this condition, in its earliest stages include – the foot becomes red, feels warm to the touch and there is significant swelling of the extremity. As there are several rules related to reporting this diabetic foot condition, medical billing and coding can be complex. Physicians treating this condition need to be familiar with the specific ICD-10 codes and outsourcing medical billing and coding to an experienced service provider is a reliable strategy to ensure this.

Causes and Symptoms

Charcot’s foot commonly develops in persons who have peripheral neuropathy – a condition wherein the nerves in the lower legs and feet get damaged. The damage causes numbness and loss of sensation in the feet and legs. Charcot’s foot is most closely associated as a rare complication of diabetes, but peripheral neuropathy is with several conditions. These include – alcohol or drug abuse, infection, trauma, or damage in the peripheral nerves, leprosy, Parkinson’s disease, inflammatory conditions such as sarcoidosis or psoriasis, Spinal cord disease or injury, HIV and Syphilis. Other potential factors that can trigger the condition include – a sore or infection on your foot (that doesn’t heal), a sprain or broken bone (that doesn’t get treatment quickly) and foot surgery that heals slowly. In addition, Charcot’s foot can also occur as a complication following organ transplantation in patients with diabetes.

Common symptoms of this condition include – warmth to the touch (the affected foot feels warmer than the other), swelling or redness and numbness in the foot area, pain or soreness, increased skin temperature in the affected foot (compared with the other foot) and changes in the appearance of the feet. The condition may appear similar to osteoarthritis as the joints are stiff and fluid accumulates in them.

Diagnosing and Treating Charcot’s Foot

In most cases, a patient with Charcot Arthropathy may not experience much pain. The foot becomes red and feels warm to the touch. The condition is quite difficult to diagnose in its earliest stages, as X-rays may not yet pick up on the damage starting to occur. For this reason, it is important that the physician knows about any specific medical condition the patient has that might result in Charcot foot. Physicians in such cases may enquire about the symptoms, conduct a detailed medical history review and will carefully examine the patient’s foot. In later stages, when the condition progresses, imaging tests like X-ray, Magnetic resonance imaging (MRI) and bone scan/indium scan will be performed to view images of soft tissues of the foot and ankle, any new bone growth and detect any specific infections in the bone. Neurological examination will also be performed to identify the extent of sensory loss. These may include – Semmes-Weinstein 5.07/10 gram monofilament test (which analyzes sensitivity to pressure and touch in large nerve fibers), pinprick test (assesses ability to feel pain) and neuro-meter test (identifies peripheral nerve dysfunction such as diabetic neuropathy). Physicians will also test the tendon reflexes and analyze the muscle tone and strength in the leg and foot.

Treatment modalities for Charcot’s foot aims to take the extra weight off the foot, heal the broken bones, as well as prevent further deformity and joint destruction. The first and foremost treatment is to take rest or take the weight off the affected foot (also called “offloading”). In the early stages of this condition, offloading helps prevent inflammation and stops the condition from getting worse and prevents deformity.

Other non-surgical treatment modalities include – wearing a protective splint, walking brace, or customized walking boot, using an orthotic brace (to correct the alignment of the foot), using a cast boot to protect the foot and minimizing or eliminating all weight on the affected foot by using a wheelchair, crutches, or a walking scooter. These supports may be required for several months or longer. However, it is important for patients to consult their physicians regularly during this time to monitor the degree of progress. If only one foot is affected, the other foot is monitored for symptoms during this time. Once the foot gets healed, patients may be asked to wear therapeutic shoes or diabetic footwear to reduce or eliminate the chances of getting Charcot foot in the future. If any of the above non-surgical treatment modalities do not give the desired results, surgery may be recommended as a last option if the foot has become significantly unstable, if the foot deformity puts the patients at a high risk for ulcers, or if protective shoe wear is not really effective.

Orthopedic surgeons, podiatrists or other specialists who treat Charcot’s Foot rely on reputable medical billing companies for accurate documentation. ICD-10 codes for Arthropathies come under the M14 code category. ICD-10 codes for diagnosing Charcot’s foot include –

  • M14.67 – Charcot’s joint, ankle and foot
  • M14.671 – Charcot’s joint, right ankle and foot
  • M14.672 – Charcot’s joint, left ankle and foot
  • M14.679 – Charcot’s joint, unspecified ankle and foot

Charcot foot is a distressing condition, but it can be avoided in some cases. Early detection is crucial for preventing damage and potential amputation. If diagnosed early, Charcot foot can at times be corrected through conservative treatments. In other instances, surgery may be necessary. The earlier the condition is diagnosed and treated, the better will be the final outcome. Possible prevention strategies include – controlling blood sugar levels, avoiding sports or exercises that impact the feet (such as kickball or soccer), performing regular self examinations of foot (to check for early symptoms) and getting professional checkups on a regular basis.

The support of an experienced medical coding service provider could be invaluable to document Charcot’s foot correctly. Coders in reliable medical coding outsourcing companies would ensure accurate reporting of diagnostic details. If the documentation is incomplete in any way, they will ask the physician for additional clarification. This will help avoid denied and delayed claims.

Natalie Tornese

Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.

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