Podiatry Coding & Billing Alert

Tip: Calcaneal spurs and heel spurs are one and the same.

If your podiatrist performs surgery to treat heel spurs, you must check the medical documentation for numerous details, including whether your podiatrist removed part of the calcaneus during the surgery. Additionally, if your podiatrist also applied a cast during the procedure, you must know the global period rules.

Review these tips and test yourself with the coding example to keep your heel spur skills sharp.

Tip 1: Discover Heel Spur Surgery Options

First, a definition. Heel spurs — also known as calcaneal spurs — may be caused by tears in the origin of the plantar fascia at the calcaneus. A tear on the heel bone may occur because of excessive use or microtrauma. If the tear does not heal completely, calcium deposits can form an exostosis or protrusion, creating a heel spur.

If your podiatrist performs surgery to remove a heel spur, you have three different CPT^® codes to choose from.

Code 28119: In this operation, the surgeon excises the calcaneus bone and, if required for pain relief and enhancement of movement range, may conduct a release of the plantar fascia. If your podiatrist performs a calcaneal ostectomy for a spur, with or without a fascial release to excise the spur, you should report 28119 (Ostectomy, calcaneus; for spur, with or without plantar fascial release). You should also check the operative note to confirm any fasciotomy your podiatrist performed.

Fasciotomy defined: A procedure in which the fascia is cut to relieve pressure in the muscle compartment.

Code 28118: On the other hand, if your podiatrist removes a part of the patient’s calcaneus instead of a spur, report 28118 (Ostectomy, calcaneus).

According to Jennifer McNamara, CPC, CCS, CRC, CPMA, CDEO, COSC, CGSC, COPC, director of healthcare training and practice support at Healthcare Inspired LLC, in Bella Vista, Arkansas, “It is important to take note of the medical necessity and/or diagnosis.

Code 28119 in the description should show a spur regardless of fascial release. For 28118 you would not see a fascial release and would expect a different diagnosis such as infection or necrosis.”

Ostectomy defined: An ostectomy is defined as surgical removal of all or part of a bone.

Code 20551: If your podiatrist gives the patient a corticosteroid injection in their foot that includes both the plantar fascia and the area around the heel spur to reduce inflammation, you should report 20551 (Injection(s); single tendon origin/insertion) for the injection, along with any appropriate J code(s) for the medication.

Tip 2: Report These ICD-10-CM Codes for Heel Spurs

If your podiatrist diagnoses a patient with a heel spur, you should look to the following ICD-10-CM codes:

• M77.30 (Calcaneal spur, unspecified foot)
• M77.31 (Calcaneal spur, right foot)
• M77.32 (Calcaneal spur, left foot)

Tip 3: Remember to Report Cast Application

In some cases, when your podiatrist performs a heel spur excision, they may also need to apply a walking cast at the time of the surgery. The cast your podiatrist applies at the time of the surgery is included in the 90-day global surgery package. However, you may report subsequent casts, if applicable. For example, if your podiatrist applies a short leg cast, you can report 29405 (Application of short leg cast (below knee to toes)).

Take note: If your podiatrist changes a cast during a global period, there must be a medical cause for the change documented in the notes.

Example: Your podiatrist must change a patient’s cast because of a stage 1 pressure ulcer on their right heel. On your claim, you should report 29405 and append modifier 58 (Staged or related procedure or service by the same physician during the postoperative period). For the ICD-10-CM code, you should report L89.611 (Pressure ulcer of right heel, stage 1).

Test Your Heel Spur Coding Skills

Scenario: The podiatrist performed a calcaneal spur resection with plantar fascial release of the left foot. Using C-arm fluoroscopy guidance, they inserted an 18-gauge needle from the heel in a distally placed position, aiming toward the spur. The C-arm fluoroscopy confirmed that the trajectory was correct and placed on the spur. The podiatrist replaced the 18-gauge needle with a #15 blade, which they inserted percutaneously and made contact with the spur. The practitioner noted complete release of the medial and central bands of the plantar fascia under the C-arm fluoroscopy. They inserted a rasp and carefully resected the calcaneal spur. The C-arm fluoroscopy confirmed satisfactory reduction of the calcaneal spur and complete resection of the plantar fascia. The podiatrist used sterile saline to irrigate the incision and close the incision with 4-0 Prolene.

Answer: To correctly code this procedure, you should report code 28119. In the above documentation, the application of 28119 is made clear first by the indication of treatment of the spur. “When the physician documents immediate release of the medial and central bands, this confirms the additional work of 28119. It also is confirmed that the spur is reduced and ostectomy is complete,” says McNamara.

Don’t miss: If the podiatrist had excised the heel spur and removed a part of the calcaneus, you would report 28118 instead.