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ICD-10 Guide
ICD-10 CodesM21.542

M21.542

Billable

Acquired clubfoot, left foot

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/17/2025

Code Description

ICD-10 M21.542 is a billable code used to indicate a diagnosis of acquired clubfoot, left foot.

Key Diagnostic Point:

Acquired clubfoot, also known as talipes equinovarus, is a deformity characterized by the foot being twisted out of shape or position. In the case of acquired clubfoot, this condition develops after birth due to various factors such as trauma, neurological disorders, or muscular imbalances. The left foot is specifically affected, leading to a plantar flexed position, adduction of the forefoot, and inversion of the heel. This condition can result in significant functional impairment, pain, and difficulty in ambulation if not addressed. Treatment often involves a combination of physical therapy, orthotic devices, and surgical interventions aimed at correcting the foot's position and restoring normal function. The complexity of managing acquired clubfoot lies in the need for a multidisciplinary approach, including orthopedic specialists, physical therapists, and sometimes neurologists, to address the underlying causes and provide comprehensive care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between congenital and acquired forms of clubfoot.
  • Understanding the underlying causes of acquired clubfoot.
  • The need for multidisciplinary documentation and coordination.
  • Variability in treatment approaches and outcomes.

Audit Risk Factors

  • Inadequate documentation of the acquired nature of the condition.
  • Failure to document associated conditions or comorbidities.
  • Lack of clarity in treatment plans and outcomes.
  • Inconsistent coding practices among different providers.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed clinical notes on the deformity, treatment plans, and follow-up assessments.

Common Clinical Scenarios

Patients presenting with foot deformities, post-surgical follow-ups, and rehabilitation assessments.

Billing Considerations

Ensure all relevant imaging and diagnostic tests are documented to support the diagnosis.

Physical Therapy

Documentation Requirements

Progress notes detailing therapy interventions, patient response, and functional outcomes.

Common Clinical Scenarios

Patients undergoing rehabilitation for foot deformities, including strength and mobility assessments.

Billing Considerations

Document specific therapeutic exercises and their impact on the patient's condition.

Coding Guidelines

Inclusion Criteria

Use M21.542 When
  • According to ICD
  • 10 guidelines, M21
  • 542 should be used when the condition is specifically acquired and affects the left foot
  • Coders must ensure that the documentation supports the diagnosis and that any associated conditions are also coded appropriately

Exclusion Criteria

Do NOT use M21.542 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

28200CPT Code

Correction of clubfoot

Clinical Scenario

Used during surgical intervention for acquired clubfoot.

Documentation Requirements

Surgical notes detailing the procedure and pre/post-operative assessments.

Specialty Considerations

Orthopedic surgeons must document the rationale for surgical intervention.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of acquired conditions like clubfoot, improving the accuracy of patient records and treatment plans. This specificity aids in better tracking of outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of acquired conditions like clubfoot, improving the accuracy of patient records and treatment plans. This specificity aids in better tracking of outcomes and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of acquired conditions like clubfoot, improving the accuracy of patient records and treatment plans. This specificity aids in better tracking of outcomes and resource allocation.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the difference between congenital and acquired clubfoot?

Congenital clubfoot is present at birth and is typically due to genetic factors, while acquired clubfoot develops later in life due to trauma, neurological conditions, or muscular imbalances.