September Schoolyard Setbacks

by Dianna Foley, RHIA, CHPS, CCS, CDIP

Test your ICD-10-CM injury and external cause knowledge by coding the scenarios below. 

A week after school began, the Klutz children were back in their routines, which meant backpacks, buses, sports, and the usual number of unexpected medical visits.

Little Dana came home from school complaining that her throat hurt. By bedtime, she had a fever, swollen glands, and white patches on her tonsils. The pediatrician performed a rapid test and diagnosed streptococcal tonsillitis.

Peter was showing off on the monkey bars during recess when he missed the last bar and landed hard on his left wrist. X-rays confirmed a closed torus fracture of the distal radius.

Egon, a member of the marching band, spent Friday night at the football field and was bitten repeatedly by mosquitoes. Two days later, one bite on his ankle became red, warm, and swollen. He was diagnosed with cellulitis of the left lower limb.

Raymond borrowed a classmate’s water bottle during gym because he forgot his own. A few days later, he developed painful blisters around his mouth and was diagnosed with herpesviral gingivostomatitis.

Janine volunteered to help decorate the high school safety bulletin board. Unfortunately, she punctured her right index finger with a staple while removing old decorations. The wound was cleaned, and she was treated for a puncture wound without foreign body.

Mrs. Klutz made a note to add hand sanitizer, bandages, and a healthy respect for gravity to the back-to-school shopping list.

 

Click HERE for the answers.

 

Antepartum Care Coding

This edition of “Spotlight on CPT” focuses on antepartum care coding, an area that will see significant change with the 2027 CPT code set.

Antepartum care refers to the period of pregnancy prior to the onset of labor. Historically, maternity care coding has relied heavily on global codes that captured large portions of pregnancy care under one reporting structure. The 2027 changes move away from that global approach and instead focus on the specific phase of care being provided.

Under the revised structure, antepartum care will be reported with evaluation and management codes rather than the current antepartum care-only codes. This change allows the code assignment to better reflect the location and level of service provided. Office, hospital, observation, home, residence, telemedicine, and critical care services will each be captured through the appropriate E/M code family.

For office or outpatient antepartum visits, codes 99202-99205 and 99211-99215 may be used. Telemedicine services may be reported with codes 98000-98015 or 98016, while home or residence services may be reported with codes 99341-99350. Hospital inpatient and observation services continue to be captured with the applicable initial, subsequent, or same-day admission and discharge codes. Critical care, when supported, may be reported with 99291 and 99292.

A key coding concept involves patients who are evaluated at one site and then admitted to the hospital or placed in observation. For example, a patient may first be seen in the office or emergency department before being sent to the hospital for additional monitoring or treatment. In these cases, it is appropriate to report the service at the initial site separately when supported by documentation. Modifier 25 should be appended to the separately identifiable E/M service.

The 2027 transition will also affect patients whose antepartum care spans both 2026 and 2027. For services provided in 2026, current CPT coding still applies, including 59425 for four to six antepartum visits and 59426 for seven or more visits. For one to three antepartum visits, the appropriate E/M codes are reported. Beginning in 2027, antepartum care will be reported per visit using E/M codes.

The antepartum procedures and fetal invasive services section is also being restructured. Code 59050 for fetal monitoring during labor by a consulting physician with written report is deleted. Code 59051 remains available for fetal heart tracing interpretation and report. Several codes are also pulled into the antepartum procedure section, including cervical cerclage, external cephalic version, multifetal pregnancy reduction, and removal of cerclage suture under anesthesia.

These revisions reflect the changing way maternity care is delivered. Not all patients receive every phase of care from the same physician or qualified health care professional. Patients may receive antepartum care from one provider, labor management from another, and delivery or postpartum care from yet another. The revised CPT structure allows each phase of care to be reported more accurately.

Now, light has been shed on antepartum care coding in the 2027 CPT maternity care revisions.

About the Author

Dianna Foley, RHIA, CCS, CDIP, CHPS, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as a program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.

A Step in the Right Direction?

Plantar fasciitis. Plantar fascial fibromatosis. Two conditions involving the plantar fascia that sound similar but do not represent the same disease process. Beginning October 1, 2026, the FY2027 ICD-10-CM code updates will separate the conditions more clearly and provide laterality-specific code choices. In this segment of “In the kNOW”, we’ll review what is changing and why the exact diagnosis matters.

Let’s begin with the anatomy. The plantar fascia is a thick band of tissue that runs along the bottom of the foot and supports the arch. Plantar fasciitis occurs when this tissue becomes irritated or degenerative, commonly producing heel pain that is often worse with the first steps in the morning or after a period of rest. Plantar fascial fibromatosis is different. It is a benign fibroblastic disorder that produces firm nodules or thickening within the plantar fascia and is also known as Ledderhose disease.

Through September 30, 2026, plantar fasciitis is listed as an inclusion term under M72.2, Plantar fascial fibromatosis. That placement can make the conditions appear interchangeable, but they are clinically different. With the FY2027 update, the inclusion term “Plantar fasciitis” is deleted from M72.2 and a new category, M67.A, is added specifically for plantar fasciitis.

The new plantar fasciitis code structure includes the following:

• M67.A01 Plantar fasciitis, right foot
• M67.A02 Plantar fasciitis, left foot
• M67.A09 Plantar fasciitis, unspecified foot

The M67.A0 subcategory identifies plantar fasciitis of the foot, but code assignment must continue to the laterality-specific code. When the medical record identifies the right or left foot, the unspecified code should not be selected simply because the final diagnosis statement does not repeat the side. Coding professionals should review the complete record and follow applicable documentation and coding requirements.

Plantar fascial fibromatosis remains classified under M72.2, but the category is also expanded to capture laterality. Ledderhose disease is added as an inclusion term, reinforcing that the fibromatosis codes identify the nodular fibroblastic condition rather than plantar fasciitis. The new code choices are: 

• M72.20 Plantar fascial fibromatosis, unspecified foot
• M72.21 Plantar fascial fibromatosis, right foot
• M72.22 Plantar fascial fibromatosis, left foot

The code change places greater importance on two pieces of documentation: the specific diagnosis and the affected foot. Heel pain alone should not be coded as plantar fasciitis without a provider diagnosis, and a plantar nodule should not automatically be coded as plantar fascial fibromatosis. When the documentation uses the terms inconsistently or does not clearly identify the condition, a query may be needed rather than selecting a code based only on symptoms or imaging findings.

To apply the change, review this scenario. A patient is evaluated for sharp right heel pain that is most severe after getting out of bed. The physician’s final diagnosis is right plantar fasciitis. For an encounter on or after October 1, 2026, the proper code assignment is M67.A01, Plantar fasciitis, right foot. M72.21 would not be appropriate because the physician did not diagnose plantar fascial fibromatosis.

Now consider a second patient with a firm nodule along the medial plantar fascia of the left foot. Following evaluation, the physician documents plantar fascial fibromatosis, also referred to as Ledderhose disease. The proper code assignment is M72.22, Plantar fascial fibromatosis, left foot. Even though both patients have a condition involving the plantar fascia, the code pathways are no longer the same.

Two additional points. First, the Excludes1 note under M72.8 is revised to direct plantar fasciitis to M67.A0-, supporting the separation of the two conditions. Second, the FY2027 codes apply to applicable encounters and inpatient discharges occurring on or after October 1, 2026. Services provided before that date must be coded using the code set in effect for the applicable date.

The revised structure gives coding professionals greater specificity, but accurate assignment will depend on documentation that clearly distinguishes plantar fasciitis from plantar fascial fibromatosis and identifies laterality.

Now you are In the kNOW!!

 

About the Author

Dianna Foley, RHIA, CCS, CDIP, CHPS, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as a program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.

You Don’t Have to Figure It Out Alone: Connect Through OHIMA Collaborate Communities

In health information management, we’re constantly learning, adapting, and solving new challenges. But you don’t have to figure it all out on your own.

Sometimes the best resource isn’t a manual, a webinar, or a Google search—it’s another HI professional who has been there before.

That’s the idea behind OHIMA Collaborate Communities: creating opportunities for OHIMA members to connect with peers, share experiences, exchange ideas, and learn from one another - all for FREE as an OHIMA member benefit!

Find Your HI Community

Collaborate Communities bring together OHIMA members with shared interests and areas of expertise. They provide a space to ask questions, discuss challenges, share resources, and discover how other professionals are approaching the work.

Currently, OHIMA offers two Collaborate Communities:

⮞ Pediatric Coding Collaborative
Connect with fellow professionals who work in pediatric coding to discuss challenges, share knowledge, and learn from one another’s experiences.

⮞ Release of Information Collaborative
Exchange ideas and best practices with professionals working in Release of Information and connect with others who understand the unique challenges of this area.

Whether you’re looking for a fresh perspective on a tricky situation or simply want to connect with others who understand what you do, these communities provide a place to start.

Your Peers Are Your Best Resource

Every organization does things a little differently. That’s what makes peer-to-peer collaboration so valuable.

You may have a process that works particularly well for your team. Another professional may have found a solution to a challenge you’re currently facing. Someone else may have a resource or perspective that gives you an entirely new way of looking at a problem.

That’s the power of collaboration.

By participating in an OHIMA Collaborate Community, you can:

• Connect with HI professionals across Ohio.
• Share your experiences, knowledge, and resources.
• Learn how others are approaching common challenges.
• Ask questions and get perspectives from your peers.
• Discover best practices you can bring back to your organization.
• Build your professional network beyond your own workplace.

And you don’t have to be a seasoned expert to participate. Sometimes simply asking a question can start a conversation that benefits an entire community.

Make Your Voice Part of the Conversation

OHIMA is more than an association—it’s a community of professionals who share a passion for health information management.

Collaborate Communities are one more way to make that community stronger.

So, if you’ve ever thought, “I wonder how other HI professionals are handling this…” this is your opportunity to find out.

Join the conversation. Share what you know. Learn from what others know. And help make Ohio’s HI community stronger—together.

Ready to Collaborate?

Visit the OHIMA Collaborate Communities page to learn more about the communities available and get connected.

Explore Collaborate Communities →

Your next great idea—or your next great connection—could be just a conversation away.