Podiatry Coding & Billing Alert

Hint: Don’t confuse calcaneal stress fractures and heel spurs.

Do you know what ICD-10 codes you should look to when reporting heel spurs? Or what CPT^® code you should report if the podiatrist removes part of the calcaneus when he excises the heel spur? How about if the podiatrist removed part of the calcaneus when excising the spur?

Read on to get all your burning heel spur questions answered.

FAQ 1:  What are heel spurs?

Answer 1: Heel spurs, also called calcaneal spurs, may be caused by the tears in the origin of the plantar fascia at the calcaneus. The plantar fascia is a layer of fibrous connective tissue that originates in the heel bone and fans out to insert in the metatarsals. Due to excessive use or microtrauma, the plantar fascia may tear at its origin on the heel bone. If adequate healing does not occur, calcium deposits may collect to form an exostosis or protrusion, which constitutes the heel spur.

FAQ 2: What are the ICD-10 choices for reporting heel spurs?

Answer 2: The following codes are your ICD-10 options for heel spurs:

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

FAQ 3: What CPT^® code should you report if your podiatrist excises a calcaneal spur, with or without plantar fascial release?

Answer 3: You will report 28119 (Ostectomy, calcaneus for spur, with or without plantar fascial release) if your surgeon excises a calcaneal spur. You should report this code regardless of whether the podiatrist makes release incisions on the stressed or irritated plantar fascia.

FAQ 4: If the podiatrist removes part of the calcaneus when he excises the spur, which CPT^® code should you report?

Answer 4: If the podiatrist removes a part of the calcaneus, you should report 28118 (Ostectomy, calcaneus).

FAQ 5: What CPT^® code should you report if the podiatrist administers an injection that included both the plantar fascia and the area around the calcaneal spur? And how many units of this injection code can you report?

Answer 5: You would report 20551 (Injection(s); single tendon origin/insertion) if the podiatrist administers an injection that includes both the plantar fascia and the area around the calcaneal spur. Also, don’t forget to report the appropriate J codes if your podiatrist uses corticosteroid injections to reduce the inflammation.

As far as how many units you can report, you can only report one injection, according to Arnold Beresh, DPM, CPC, CSFAC, in West Bloomfield, Michigan.

“When giving the injection, you can report the number of units of steroid depending on what steroid is used,” Beresh adds.

FAQ 6: How would my coding change if I am reporting a calcaneal stress fracture rather than a heel spur?

Answer 6: Heel spur and calcaneal stress fracture are entirely different conditions, and you should report a code from category M84.37- (Stress fracture, ankle, foot and toes) because the podiatrist is examining the heel and foot. However, you need to be sure you report the code with the highest specificity.

As for your CPT^® options you can look to codes 28400 (Closed treatment of calcaneal fracture; without manipulation) through 28420 (Open treatment of calcaneal fracture, includes internal fixation, when performed; with primary iliac or other autogenous bone graft (includes obtaining graft)), depending upon the treatment details in the op report.