Podiatry Coding & Billing Alert

Spring is upon us, and as more people are outside enjoying the weather, your podiatrist will probably see an uptick in sports-related injuries. When you report these injuries, you should pay attention to crucial documentation details so you can submit the appropriate ICD-10-CM and CPT^® codes.

Heel spurs defined: Heel spurs may be caused by tears in the origin of the plantar fascia at the calcaneus. The plantar fascia may tear at its origin on the heel bone 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.

ICD-10-CM codes: If your podiatrist diagnoses a patient with a heel spur, you should look to ICD-10-CM codes M77.31 (Calcaneal spur, right foot) and M77.32 (Calcaneal spur, left foot).

Treatment options: Some nonsurgical options for heel spurs include physical therapy, heel stretching exercises, orthotics, muscle and tendon tapping, and anti-inflammatory medication.

On the other hand, if your podiatrist performs surgery on the heel spur, you have a couple of code options. First, if your podiatrist excises a heel spur, with or without plantar fascial release, report code 28119 (Ostectomy, calcaneus; for spur, with or without plantar fascial release). You should report this code regardless of whether the podiatrist makes release incisions on the stressed or irritated plantar fascia.

If your podiatrist removes a part of the patient’s calcaneus when he excises the spur, report 28118 (Ostectomy, calcaneus).

Finally, if your podiatrist administers an injection that included both the plantar fascia and the area around the calcaneal spur, report 20551 (Injection(s); single tendon origin/insertion). Don’t forget to report the appropriate J codes if your podiatrist uses corticosteroid injections to reduce the inflammation.

Pinpoint Treatment Options for Sesamoiditis

Sesamoiditis is an injury you will often see in runners, baseball players, and dancers. The sesamoids are tiny bones in the tendons that run to the big toe. These bones serve as a pulley and increase the leverage of tendons of the big toe. Since the sesamoids are within the tendon, sesamoiditis is a kind of a tendonitis. When the patient exerts incredible force on their sesamoid bones, inflammation and fractures can occur.

ICD-10-CM codes: For sesamoiditis, report ICD-10-CM codes M25.871 (Other specified joint disorders, right ankle and foot) and M25.872 (Other specified joint disorders, left ankle and foot).

Treatment options: Nonsurgical treatment options for sesamoiditis include resting, wearing protective padding your foot, and taking over-the-counter pain relievers.

On the other hand, if your podiatrist opts for surgery to treat sesamoiditis, you should look to code 28315 (Sesamoidectomy, first toe (separate procedure)) for the total or partial removal of the sesamoid bones.

Learn About Most Common Type of Neuroma

Athletes such as soccer, baseball, and softball players, and golfers who wear shoes that constrict their forefoot are more susceptible to Morton’s neuroma.

Morton’s neuroma defined: Morton’s neuroma, the most common type of neuroma, is a sustained irritation or inflammation that causes perineural fibrosis and thickening of the communicating branch between the medial and lateral plantar nerves in the third interspace between the third and fourth metatarsals.

ICD-10-CM codes: You should report ICD-10-CM codes G57.61 (Lesion of plantar nerve, right lower limb), G57.62 (Lesion of plantar nerve, left lower limb), and G57.63 (Lesion of plantar nerve, bilateral lower limbs) for Morton’s neuroma.

Treatment options: Nonsurgical treatment for Morton’s neuroma includes medication such as Tylenol or non-steroidal anti-inflammatory drugs (NSAIDs) for pain, ice and/or physical therapy, as well as orthotics.

If your podiatrist opts for surgery to treat the Morton’s neuroma, you have several options. First, if your podiatrist administers a steroid injection for temporary relief of the Morton’s neuroma, you should report code 64455 (Injection[s], anesthetic agent[s] and/ or steroid, plantar common digital nerve[s] [eg, Morton’s neuroma])). In this procedure, the podiatrist injects a corticosteroid (such as triamcinolone, depomedrol, or prednisone) with an anesthetic around the nerve, which relieves the pressure on the nerve.

However, if your podiatrist destroys the nerves that are responsible for carrying pain, you should report code 64632 (Destruction by neurolytic agent; plantar common digital nerve) for a neurolytic injection.

Finally, your podiatrist may choose to excise a Morton’s neuroma. In this case, you should report 28080 (Excision, interdigital (Morton) neuroma, single, each).

Don’t Forget the DME

Durable medical equipment (DME) is also an important part of patient care for sports-related injuries, Jordan explains.

“When billing for these items, you will need to choose the most accurate HCPCS code for the product you are dispensing,” Jordan says. “It is essential that you know the requirements of the patient’s plan. Many insurances, for example, only allow one DME every five years. Your physician needs to document the need for the DME and have the patient sign a proof of delivery.”