Podiatry Coding & Billing Alert

Chances are your podiatrist treats numerous cases of plantar fasciitis — inflammation of the plantar fascia — in your practice. When you report these claims, you must check your podiatrist’s medical documentation to see exactly what treatment option he performed.

Read on to learn more.

Step 1: Podiatrists Turn to Conservative Treatments First

When a patient has plantar fasciitis, your podiatrist will prescribe conservative treatment options first. These include the following:

• Rest
• Ice
• Foot stretching
• Nonsteroidal anti-inflammatory drugs (NSAIDS)
• Physical therapy
• Shoe inserts
• Use of stretching boots

Step 2: Report Plantar Fasciitis Injections This Way

If conservative treatment options do not heal the patient’s plantar fasciitis, then your podiatrist may administer an injection for treatment.

If your podiatrist performs the injection directly into the tendon, then you should report 20550 (Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar “fascia”)) for an injection of the plantar fascia. The code descriptor for 20550 specifies “aponeurosis (eg, plantar ‘fascia’).

On the other hand, if your podiatrist performs the injection in the area where the tendon attaches to the bone, you should report 20551 (Injection(s); single tendon origin/insertion).

Don’t miss: In the cases of injections 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.

Step 3: Identify Correct Codes for Plantar Fasciitis Surgery

If conservative options and injections don’t heal the patient’s plantar fasciitis, then your podiatrist will turn to surgical options. You have many plantar fasciitis surgery codes to choose from including the following:

• 28008: 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, you should report code 28008 (Fasciotomy, foot and/or toe). Code 28008 is most often done as a percutaneous procedure, says Arnold Beresh, DPM, CPC, CSFAC, in West Bloomfield, Michigan.
• 28060: When your podiatrist cuts and removes a piece of the plantar fascia, you should report 28060 (Fasciectomy, plantar fascia; partial (separate procedure)). You should report 28060 for the partial removal of the plantar fascia using high frequency electrosurgery, per CPT^® Assistant Vol. 18, No. 3. “Code 28060 is neither tool nor technique dependent.”
• 28062: When your podiatrist removes one third of the plantar fascia or more, you should report 28062 (Fasciectomy, plantar fascia; radical (separate procedure)).
• 28250: When your podiatrist performs a repair or reconstruction of the plantar fascia, such as the repair of a rupture plantar fascia, you should report 28250 (Division of plantar fascia and muscle (eg, Steindler stripping) (separate procedure)).

“Plantar fasciitis can be one of the more frustrating condition to treat, not only for the patient but also for the physician,” Beresh says. “As we have seen, there are many treatment methods, but no one treatment for all. It is not unusual for plantar fasciitis to take five to six months to resolve.”

Step 4: Don’t Forget ESWT As Treatment Option

In some cases, your podiatrist may perform extracorporeal shock wave therapy (ESWT) to treat the patient’s plantar fasciitis.

For ESWT for plantar fasciitis, you should report 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). You should only report 28890 if your podiatrist performs this procedure under general or regional anesthesia.

Example: The podiatrist administered high-energy sound waves to the sole of the patient’s foot to stimulate healing of the plantar fascia. He used ultrasound guidance to guide the procedure. The podiatrist performed the ESWT with the patient under regional anesthesia.

You should report 28890 on your claim for the ESWT.