Monday, November 12, 2018

Nutty Thanksgiving ICD-10 Codes

Ahhh, the things doctors have to go through to get paid by insurance companies and Medicare. Every patient encounter has to have a diagnosis code for each problem or procedure.  The book of codes is larger than a huge phonebook. ( Note:  I do understand that readers under age 30 may not have ever seen a phonebook but use your imagination - it's thick and big)

Here are a few of the wacky codes we are required to use for these conditions. Please don't ask me who thought these up:

W61.43 - Pecked by a turkey.  (Who knew they were so dangerous?  Another reason to go Vegan?)
W60.0   - Contact with sharp leaves. (That leaf pile will decompose naturally so be safe. No need to rake)
Y92.72  - Place of occurrence-chicken coop. (Yes we also have to show where the injury occurred)
Y91.71  - Place of occurrence- barn.  (Please make it stop...)
Z63.1    - Problems in relationships with in-laws (This will be a common one this season)
Y93.E2 - Injury due to activity-laundry (Women, protect yourselves. Leave it alone)
W29.1   - Contact with electric knife (Oops)

And finally for after the meal: 
R14.1   - Gas Pain,   (followed byR-14.3 - Flatulence (accompanied by) K-30 -indigestion (and)
R-12    -  Heartburn

For Black Friday we have a code also:
W-52  -  Crushed, pushed or stepped on by crowd. (Amazon by mail anyone?)

For the Doctors and other providers of care during the holiday season there is a special code:
Z-56.6 -   Mental and Physical stress related to work.

Please forgive your Doctor for being hunched over her computer.  She has to remember or look up all of these codes.

hat tip to MedScape for the wacky codes.

Sunday, November 11, 2018

Ruptured Plantar Fascia

Many people have experienced plantar fasciitis.  It is a painful bottom (plantar surface) of the foot that often comes on after athletic exercise, prolonged hiking or running or just for no reason at all.
The plantar fascia is a band of tissue that connects the heel bone to the toes.  This wide ligament covers the entire bottom of the foot and acts like a elastic band under the arch and helps absorb shock when you walk.  Inflammation and tiny micro tears are the culprit in plantar fasciitis.  Most patients can diagnose it themselves and it rarely needs imaging or any special tests.

Bruise indicating a ruptured plantar fascia
Ruptured plantar fascia is relatively rare and the snap occurs suddenly, usually with exercise.  The force of jumping or stepping can cause a tear that causes sudden pain and inability to bear weight on that foot.  The injured athlete often feels a "pop" when the fascia snaps.  Within 24 hours the blood from the tear forms a bruise on the bottom of the foot.

So what should be done for a torn plantar fascia?  Like any muscular injury, ice is the first treatment.  It not only limits further bleeding and swelling, it also provides pain relief.  Elevation and compression (ace wrap) are also first treatments.  An ultrasound is usually as effective as an MRI for seeing the ligament but the diagnosis does not require any imaging.  Physical therapy and using a walking boot are helpful for the first few weeks of healing.  It is very rare that surgery is needed.  The fascia forms a scar and heals itself.  Sometimes shoe orthotics are used to support the arch during healing.

The best way to keep your feet healthy and prevent plantar injuries are:

Weight control
Never get a steroid injection into the plantar fascia (it is a risk factor for rupture)
Stretching the toes and feet before activity
Stretch the arch of your feet
Stretch the achilles tendon (it's all connected)
Wear good athletic and walking shoes with arch support
Use heel cups or shoe inserts (over the counter is fine)
Flex your feet/toes upward when you are in bed and before you get up in the morning.

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