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How to correctly code bunions a common bone deformity
How to Correctly Code
Bunions - A Common Bone
Bunions are bony lumps that form on
the side of the feet. Read the article
to know more about the symptoms,
causes, treatments and ICD-10 codes
related to this bone condition.
Outsource Strategies International
A bunion is a bony bump that primarily forms on the joint at the base of the big toe. Also
known as “Hallux Valgus”, this bone deformity occurs when the bone of the big toe
excessively angles or pushes against the next toe (instead of straight ahead), forcing the
joints to get bigger and protrude. Overtime, the normal structure of the bone changes,
resulting in a bony bump and the skin over the bunion may turn red and become sore. In
some cases, bunions may also occur near the base of the little toe instead of the big toe –
known as bunionettes or "tailor's bunion." This progressive bone disorder is most often
caused by an inherited structural defect, stress on your foot, or a medical condition such as
arthritis. If left untreated, this bone defect will gradually increase and make it extremely
painful to wear shoes or even walk properly. Treatment options for this bone condition vary
depending on the severity of the bunion and the amount of pain it causes. Podiatry
medical billing may involve several challenges. Podiatrists and other specialists offering
treatment for bunions need to ensure that the medical billing and coding for this bone
deformity is done properly on the medical claims. Choosing the service of a reliable and
established medical billing company would be a practical solution.
Any person can get a bunion, but this condition tends to be more common in women. This
may be due to the tight, narrow shoes that squeeze the toes together – which may
aggravate already-existing bunions or cause bunions to develop in people with a genetic risk
of the condition. In most cases, bunion pain is relieved by wearing wider shoes with
adequate toe room and using other simple treatments to reduce pressure on the big toe.
Types of Bunions and Causes
Generally, bunions tend to develop due to a defective mechanical structure of the foot,
which is genetic. Other related factors include – foot injuries, overpronation (having a low
arch or uneven weight-bearing in the foot and tendon), flat feet, neuromuscular conditions
like cerebral palsy, hyper mobility, having a big toe bone that moves more than usual,
deformities present at birth (congenital), types of arthritis, (such as rheumatoid arthritis)
and other conditions that affect both the nerves and muscles, such as polio. The different
types of bunions include –
Bunion with Skin Irritation – In this type, the bump on the side of the big toe
joint may be red and painful from rubbing against the shoe. Inflammation of the big
toe joint and surrounding area may also contribute to the pain.
Large Bunion – Generally a large type, this bone deformity occurs at the big toe
joint and is most likely to be viewed on an X-ray.
Bunion with Hallux Limitus – As the name suggests, this is a smaller type of
bunion often seen with a condition called hallux limitus and is characterized by
limited range of motion at the big toe joint.
Tailor's Bunion – Also known as bunionette, this bump caused by the abnormal
foot structure or function, forms on the pinkie toe side of the foot.
In the early stages of bunion formation, many people do not experience any specific
symptoms. Symptoms often become noticeable when the bony bumps get worse with
wearing certain types of footwear like shoes with a tight toe box or high-heeled shoes. In
addition, spending long periods of time on your feet can aggravate the symptoms of
bunions. When symptoms do occur, these may include -
A bulging bump on the outside of the base of your big toe
Swelling, redness, numbness or soreness around your big toe joint
Persistent or intermittent pain
Increased skin thickness at the base of the affected toe
Hardened skin under the foot
Corns or calluses (often develop where the first and second toes overlap)
A burning sensation
What Are the Treatment Options?
Diagnosis of this bony condition starts with a detailed physical examination of the bunions.
An X-ray of the foot will also be taken to identify the root cause of the deformity and its
severity which in turn will help direct the next stage of treatment. Treatment options for this
bone deformity vary depending on the severity of the bumpy growth and the amount of pain
Treatment modalities may involve non-surgical options and lifestyle adaptations like –
choosing appropriate fitting footwear, shoe inserts/orthotics, padding, taping, or splinting of
the toe and applying ice to the affected area will help relieve soreness and inflammation.
Usage of medications like - acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB,
others) or naproxen sodium (Aleve) can help control the pain caused by a bunion. In
addition, cortisone injections can help relieve swelling, (particularly in the fluid-filled pads
that cushion the bones).
If any of the non-invasive treatment methods does not provide the expected relief from
symptoms, surgery will be considered as a last option. However, surgery will not be
recommended unless the bone disorder interferes with the patient’s daily activities or
causes frequent pain and inflammation that does not improve with other treatments.
Surgical options include – Arthrodesis (to remove the swollen joint surface), Osteotomy (to
realign the joint), repair of the tendons and ligaments, Exostectomy (removing the bump on
the toe joint) and Resection arthroplasty (to remove the damaged portion of the toe joint
and provide more space between the toe bones).
Podiatrists who provide specialized treatment for different types of bunions are reimbursed
for their services. The correct medical codes must be used to document the diagnosis,
screening and other procedures performed. Medical billing services offered by reputable
companies can help physicians use the correct codes for their medical billing process. The
ICD-10 codes used to code bunions include –
M20.1 - Hallux valgus (acquired)
M20.10 - Hallux valgus (acquired), unspecified foot
M20.11 - Hallux valgus (acquired), right foot
M20.12 - Hallux valgus (acquired), left foot
In some cases, people tend to experience problems that continue to worsen over time, while
in other cases people do not experience any specific symptoms even with the underlying
bone deformity. There are several measures that can be opted to prevent the occurrences
of different types of bone deformities. Wearing well-fitting shoes with a wide toe box is one
of the top prevention measures. Try to avoid shoes with pointy toes and high heels.
Instead, wear a shoe with a strap or lace over the instep that holds the foot securely and
stops the foot from sliding forward.
Medical coding for foot and bone disorders can be a challenging process. For accurate and
timely medical billing and claims submission, healthcare practices can outsource their
medical coding tasks to reliable medical billing companies that provide the services of
AAPC-certified coding specialists.