10/31/2022    Eddie Davis, DPM

RE: New ICD-10 Codes (Anthony Hoffman, DPM)

I agree with Dr. Anthony Hoffman concerning the
lack of a specific ICD-10 code for Ledderhose
disease. Keep in mind that that the lack of a
specific diagnosis code not only affects our
ability to bill for treatment of this malady but
also affect data collection with respect to the
incidence and prevalence of this disease. Plantar
fibromatosis or Ledderhose disease is classified
as a rare disease but I question how rare it
actually is.

I have had an interest in Ledderhose disease for a
several decades and have developed an off label
treatment for it involving use of enzyme
injections into the lesions. Hyaluronidase has
worked well for me and I am happy to share my
protocol with anyone who is interested. There are
now phase 2 studies for Xiaflex brand collagenase.
I have a had a challenging time getting others to
be interested which I feel, again, is due to it
being viewed as a rare disease.

Radiation oncologists have taken an interest in
treatment and there have been several papers
written in the last few years on the subject of
radiation therapy for benign lesions. I feel that
use of radiation therapy should be performed
sparingly. I moderate a Facebook Group entitled,
Ledderhose disease or plantar fibromatosis support
Group. The Group has about 4300 members. The
disease can be disabling and have quite a few
members who relate significant impairments.

Use of the ICD 10 code M72.2 for Ledderhose
disease is problematic in that it is not only
nonspecific but describes pathology that is
substantially different. Obviously the prevalence
of plantar fasciitis is very high so this code has
minimal tracking value for Ledderhose. I use the
ICD-0 code D49.2, neoplasm of unspecified behavior
of bone, soft tissue or skin in conjunction with
M72.2 to help identify this entity in my office
but that combination has little value in tracking.

Disclaimer: I am a consultant for Endo
Pharmaceuticals, the manufacturer of Xiaflex.

Eddie Davis, San Antonio, TX

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