Podiatry Coding & Billing Alert

Always carefully read the medical record to make sure you understand exactly which diagnosis your podiatrist documented.

If an X-ray is done and confirms heel spurs, you can also report M77.31 (Calcaneal spur, right foot)-RT (Right side) or M77.32 (Calcaneal spur, left foot)- LT (Left side), Marcelli adds.

Plantar fasciitis defined: Plantar fasciitis is inflammation of the thick band of fascia tissue across the bottom of the foot, causing a stabbing type of foot pain.

Myth 2: Podiatrists Will Always Choose Surgery As First Treatment Option

Reality: The initial treatment for plantar fasciitis should not be surgery. Your provider will attempt more conservative means to alleviate the condition first.

Conservative treatments for plantar fasciitis include the following, according to Marcelli:

• Rest,
• Ice,
• Foot stretching,
• Nonsteroidal anti-inflammatory drugs (NSAIDS),
• Physical therapy (PT), and
• Shoe inserts

“Another tool that can be used for conservative care is to dispense a night splint,” says Jeri L. Jordan, CPC, billing manager at Hampton Roads Foot and Ankle in Williamsburg, Virginia. “Night splints for plantar fasciitis are used to keep the foot and ankle flexed to prevent shortening the plantar fascia while the patient sleeps. The splint allows the band to heal by keeping the ligament stretched.”

Myth 3: Injections Cannot Help Plantar Fasciitis

Reality: There are a few injection options to treat plantar fasciitis. The most used are 20550 (Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar “fascia”)) and 20551 (Injection(s); single tendon origin/insertion).

To choose the correct code, you will need to know the location where your podiatrist performed the injection. Your podiatrist will perform a 20550 service directly into the tendon; whereas 20551 will go in the area where the tendon attaches to the bone, so make sure you are choosing the correct CPT^® option when coding, Marcelli says.

Drug supply: Don’t forget to code the appropriate J code(s) for the drug supply/medication administered, Marcelli cautions.

In the cases of injections for plantar fasciitis, your podiatrist will usually inject corticosteroid; but you should always check the drug supply on your 20550 and 20551 claims to ensure you’re coding for the right drug.

Communication with your physician is key, according to Marcelli. “Explain how helpful it is to have them document the initial presentation and the conservative care. They should also document what the next step might be if the conservative care doesn’t help the condition; that way if the patient does come back for the injection, the physician can document ‘as previously discussed with patient the conservative care did not help alleviate the condition so today, we will proceed with an injection, etc.,’” she said.

Myth 4: You Don’t Have Many Surgical Options to Choose From

Reality: Your podiatrist may perform several different procedures to treat plantar fasciitis. These procedures are as follows. This is not an exhaustive list:

• 28008 (Fasciotomy, foot and/or toe). Note: When your podiatrist cuts the plantar tendon at the level of the toe or a portion of the plantar fascia at the proximal portion of the plantar fascia, report 28008, which is most often done as a percutaneous procedure.
• 28060 (Fasciectomy, plantar fascia; partial (separate procedure)). Note: When your podiatrist cuts and removes a piece of the plantar fascia, report 28060. Report 28060 for the partial removal of the plantar fascia using high-frequency electrosurgery, per CPT^® Assistant Volume 18, Issue 3. “Code 28060 is neither tool nor technique dependent.”
• 28062 (Fasciectomy, plantar fascia; radical (separate procedure)). Note: When your podiatrist removes one-third of the plantar fascia or more, report 28062 (Fasciectomy, plantar fascia; radical (separate procedure)).
• 28119 (Ostectomy, calcaneus; for spur, with or without plantar fascial release) (which includes ostectomy for bone spur). Note: Report 28119 when your podiatrist removes the calcaneus bone and performs a plantar fascial release to relieve pain and improve range of motion.
• 28250 (Division of plantar fascia and muscle (eg, Steindler stripping) (separate procedure)). Note: When your podiatrist performs a repair or reconstruction of the plantar fascia, such as the repair of a rupture plantar fascia, report 28250.
• 28890 (Extracorporeal shock wave, high energy, performed by a physician or other qualified health care professional, requiring anesthesia other than local, including ultrasound guidance, involving the plantar fascia). Note: When your podiatrist uses extracorporeal shock wave therapy (ESWT) to treat plantar fasciitis, report 28890. Only report 28890 if your podiatrist performs this procedure under general or regional anesthesia.
• 29893 (Endoscopic plantar fasciotomy). Note: Report 29893 when your podiatrist examines the tissue inside the patient’s heel with an endoscope to access the fascia of the plantar surface and incises the fascia to relieve plantar fasciitis pain.