ICD-10 Coding for Right Foot Contusion(S90.31XA, S90.31XD, S90.31XS)
Complete ICD-10-CM coding and documentation guide for Right Foot Contusion. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Right Foot Contusion
S90.3Primary Range
Superficial injury of foot
This range includes codes for contusions of the foot, specifically the right foot in this context.
Open wound of foot
This range is relevant for differential diagnosis when an open wound is present.
Stress fracture, foot
This range is used if imaging confirms a stress fracture instead of a contusion.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S90.31XA | Contusion of right foot, initial encounter | Use for initial encounter of a right foot contusion without fracture. |
|
| S90.31XD | Contusion of right foot, subsequent encounter | Use for follow-up visits after the initial encounter. |
|
| S90.31XS | Contusion of right foot, sequela | Use for chronic or residual effects after the active phase of treatment. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for right foot contusion
Essential facts and insights about Right Foot Contusion
Primary ICD-10-CM Codes for right foot contusion
Decision Criteria
clinical Criteria
- Presence of ecchymosis and tenderness without fracture
documentation Criteria
- Detailed mechanism of injury and location
Clinical Validation Requirements
- Documented blunt trauma to the right foot
- Absence of fracture on imaging
Code-Specific Risks
- Incorrectly coding as a fracture or open wound
Coding Notes
- Ensure laterality and encounter type are documented.
S90.31XD - Contusion of right foot, subsequent encounter
Use for follow-up visits after the initial encounter.
Applicable To
- Follow-up for right foot bruise
Clinical Validation Requirements
- Ongoing treatment for a previously documented contusion
Coding Notes
Ensure documentation reflects follow-up care.
S90.31XS - Contusion of right foot, sequela
Use for chronic or residual effects after the active phase of treatment.
Applicable To
- Chronic pain or other sequelae from right foot contusion
Clinical Validation Requirements
- Documented residual effects post-treatment
Coding Notes
Ensure documentation specifies sequelae.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Fall on same level from slipping, tripping and stumbling
W00.0XXADocumentation & Coding Risks
Avoid these common documentation and coding issues when documenting Right Foot Contusion to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S90.31XA.
Impact
Clinical: Incomplete clinical picture., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Review injury mechanism during documentation., Cross-check with external cause code list.
Impact
Clinical: Lack of specificity in patient records., Regulatory: Failure to meet documentation standards., Financial: Risk of claim rejection.
Mitigation Strategy
Use specific terms like 'right foot contusion'., Ensure detailed documentation of the injury.
Impact
Reimbursement: Incorrect DRG assignment can affect payment., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Always sequence S90.31XA first unless a more severe injury exists.
Impact
Reimbursement: Potential denial of claims., Compliance: Violation of coding rules., Data Quality: Misrepresentation of patient condition.
Mitigation Strategy
Use S90.31XS for sequelae such as chronic pain.
Impact
Using sequela codes for acute symptoms.
Mitigation Strategy
Educate staff on proper use of sequela codes.
Impact
Failure to include external cause codes when applicable.
Mitigation Strategy
Implement checklist for external cause documentation.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Right Foot Contusion, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Right Foot Contusion
Use these documentation templates to ensure complete and accurate documentation for Right Foot Contusion. These templates include all required elements for proper coding and billing.
Initial ED visit for right foot contusion
Specialty: Emergency MedicineRequired Elements
- Patient age and gender
- Mechanism of injury
- Location and size of contusion
- Imaging results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Follow-up visit for right foot contusion
Specialty: OrthopedicsRequired Elements
- Patient progress
- Changes in symptoms
- Continued treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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