June 11, 2007

Coding for Clubfoot
For The Record
Vol. 19 No. 12 P. 36

Clubfoot is a disorder that causes the foot to twist out of shape or position. Also known as talipes equinovarus, it is a congenital condition present at birth, although it may not affect the infant until he or she starts to walk. Because the foot is at a sharp angle to the ankle, the child may walk on the outside edge of the foot.

Clubfoot may range from mild to severe and affect one or both feet. Typically, the affected foot will be smaller than the unaffected or normal foot. This birth defect is not painful, and there is no known cause.

Signs and Symptoms
The most common characteristic of clubfoot is that the foot is twisted downward and inward, which is caused by a tight Achilles tendon. The patient is unable to put the foot flat on the ground. The calf muscles tend to be underdeveloped in the leg with the affected foot. The heel or hindfoot will also be turned inward, as well as the hindfoot and midfoot, giving the foot a kidney-shaped appearance.

Diagnosis
Clubfoot is typically diagnosed by appearance during the newborn physical examination. It is occasionally diagnosed by the physician during a prenatal ultrasound. The physician may perform an x-ray to determine the severity of the condition.

The ICD-9-CM code assignment for clubfoot will depend on the affected part of the foot. The following are common codes:

• 754.50, Talipes varus — the turning inward of the heel;

• 754.51, Talipes equinovarus — the turning inward of the heel with turning upward of the inner edge of the foot;

• 754.59, Talipes calcaneovarus — the turning inward of the heel with the turning upward of the toes and forefoot;

• 754.60, Talipes valgus — the turning of the heel outward;

• 754.62, Talipes calcaneovalgus — the turning outward of the foot with the turning upward of the toes and forefoot;

• 754.69, Talipes equinovalgus — the turning outward and upward of the foot;

• 754.69, Planovalgus — the turning outward of the heel with the turning upward of the outer edge of the forefoot;

• 754.70, Talipes, unspecified;

• 754.71, Talipes cavus — the congenital increased arch of the foot; and

• 754.79, Talipes equinus — the turning downward of the entire foot.

Although clubfoot is typically congenital, it is possible that it may be documented as acquired. Use the following codes if the clubfoot is documented as acquired:

• 736.71, Clubfoot, acquired (acquired equinovarus deformity) — heel turned inward with turning upward of the inner edge of the foot;

• 736.72, Equinus deformity of foot, acquired — heel elevated and turned out;

• 736.73, Cavus deformity of foot — abnormally high arch;

• 736.75, Cavovarus deformity of foot, acquired (cavovarus) — the increased arch of the foot with the turning inward of the heel;

• 736.76, Other calcaneus deformity (calcaneovalgus, calcaneovarus) — heel turn outward with anterior foot elevated; and

• 736.79, Acquired talipes, NEC (valgus, varus).

If the physician does not document that the clubfoot is either congenital or acquired, ICD-9-CM assumes the condition is congenital.

Treatment
Treatment for clubfoot usually begins shortly after diagnosis. The goal of treatment is to correct the deformity and maintain the normal positioning as long as possible to facilitate normal development.

Clubfoot may be treated with stretching and casting (Ponseti method). In severe cases, surgery may be necessary to lengthen the tendon to help ease the foot into a more appropriate position. The patient may wear leg braces to prevent recurrence after initial treatment.

Coding and sequencing for clubfoot are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to nearly 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.