Podiatry Coding & Billing Alert

Hint: Report M72.2 for plantar fasciitis.

Running puts a lot of stress on your feet, and although runners may take every precaution to ensure they don’t hurt themselves, at some point, they will probably encounter a foot injury.

If your podiatrist sees many runners in your practice, you’ll want to become familiar with common running injuries and how to code for them.

Here’s How to Handle Achilles Tendon Rupture

Achilles tendon rupture: The Achilles tendon, the largest tendon in the body, connects the calf muscles to the heel bone (calcaneous). Runners can rupture their Achilles tendon when they put too much strenuous force on it. Runners who have an Achilles tendon rupture will often feel instant pain in their foot or heel that may radiate along the back of their leg.

ICD codes: For an Achilles tendon rupture, you can choose from the following ICD-10 codes:

• S86.011A, Strain of right Achilles tendon, initial encounter
• S86.012A, Strain of left Achilles tendon, initial encounter
• S86.019A, Strain of unspecified Achilles tendon, initial encounter.

CPT^® codes: CPT^® codes to keep in mind for Achilles tendon ruptures are 27650 (Repair, primary, open or percutaneous, ruptured Achilles tendon) or (if the physician uses a graft) 27652 (Repair, primary, open or percutaneous, ruptured Achilles tendon; with graft [includes obtaining graft]).

If the runner comes in for routine postop aftercare in the office setting, report the code you used above (either S86.011- or S86.012-) but with a “D” seventh character, which represents a “subsequent encounter.”

However, if the patient suffers a spontaneous rupture after the tendon repair and requires revision surgery, use code M66.87 (Spontaneous rupture of other tendons, ankle and foot), says Heidi Stout, BA, CPC, COSC, PCS, CCS-P, with Coder on Call, Inc., in Milltown, New Jersey. Attach this to 27654 (Repair, secondary, Achilles tendon, with or without graft) to indicate multiple surgeries. Note that this code is not concerned about whether or not a graft was used.

Check Out Options for Sesamoiditis

Sesamoiditis: 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 runner exerts incredible force on his sesamoid bones, inflammation and fractures can occur.

ICD-10 codes: For sesamoiditis, you would report M25.87- (Other specified joint disorders, right ankle and foot).

CPT^® codes: A surgical option to treat sesamoiditis is 28315 (Sesamoidectomy, first toe [separate procedure]) for the total or partial removal of the sesamoid bones. Use modifier RT (Right side) or LT (Left side) with 28315 the podiatrist performs for the sesamoid under the first metatarsal head. For the removal of an interphalangeal sessamoid bone of the first toe, report TA (Left foot, great toe) or T5 (Right foot, great toe).

Look to These Codes for Plantar Fasciitis

Plantar fasciitis: The plantar fascia is a thick aponeurosis that supports the arch on the bottom (plantar side) of the foot.

When a runner experiences plantar fasciitis, the most common form of hindfoot pain, his plantar fascia becomes inflamed and painful.

Amy J. Conroy, CPC, CEMC, CSFAC, coding specialist at Twin Cities Orthopedics in Golden Valley, Minnesota experienced plantar fasciitis a few years ago when her gait changed from having an ingrown toenail removed.

“To me, that’s the most interesting part that it [plantar fasciitis] can come on from one small change in how you walk or what shoes you wear,” Conroy says.

Plantar fasciitis may be caused by different circumstances for different runners, according to Conroy.

“I have been running as a leisure activity for a few years now, and I have run with people who run in the same shoes they’ve run in for years, or some wear cheap shoes with little to no support, and some buy the fanciest, most expensive running shoes out there and yet, they each can end up with pain and a diagnosis of plantarfasciitis,” Conroy says.

From a coding perspective, Conroy points out how important it is to know the anatomy and physiology of the area you are coding.

“If you’re a runner and are diagnosed with plantar fasciitis, is it your gait, biomechanicsor something else that is causing it?” Conroy says. “Is it an actual ‘injury’ or is it sudden inflammation from lack of proper stretching or heel strike when running?”

ICD-10 codes: Most plantar fasciitis pain is located close to where the fascia attaches to the heel bone. The exact cause of plantar fasciitis is unknown, but once your physician diagnoses plantar fasciitis, you’ll normally report M72.2 (Plantar fascial fibromatosis).

Caution: Some coders may confuse plantarfasciitis with a plantarfibroma or plantar fascia rupture/tear, but M72.2 is not a blanket code that covers all of these conditions, according to Conroy.

“If it’s a plantar fibroma, it’s going to be D21.2- (Benign neoplasm of connective and other soft tissue of lower limb, including hip),” Conroy says. “If it’s an acute injury like a tear or rupture, they’re going to need to be looking in the S96.81- (Strain of other specified muscles and tendons at ankle and foot level) section and code it as the injury.”

However, if it’s truly inflammation of the fascia, then you would code M72.2, Conroy says.

“I have seen coders attach M72.2 to anything associated with the plantar fascia since they assume that everything is plantar fasciitis,” Conroy says. “This leads back to making sure your providers are explaining and documenting their diagnoses clearly.”

Tip: To be successful when coding for plantar fasciitis, Conroy says to always read the notes and never be afraid to query your providers.

“I have been able tolearn so much from theDPMsthat I’ve worked with, and I really believe that has made me a much better coder,” Conroy says. “They are able to explain what they do or why they say what they say.”

CPT^® codes: If the patient’s pain does not improve with initial treatments like stretches, taking an anti-inflammatory drug, custom-made orthotics, etc., the physician may suggest corticosteroid shots, which you would code as 20550 (Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar “fascia”]).

Although nonsurgical options do prove successful for the majority of patients, some people may need surgery to treat their plantar fasciitis. Depending on the complexity of the surgery, you should select one of these four codes, all of which refer to plantar fascia repair:

• 28008, Fasciotomy, foot and/or toe
• 28060, Fasciectomy, plantar fascia; partial (separate procedure)
• 28062, Fasciectomy, plantar fascia; radical (separate procedure)
• 28250, Division of plantar fascia and muscle (e.g., Steindler stripping) (separate procedure).