Podiatry Coding & Billing Alert

Thorough documentation of early treatment might help justify 28890.

With heel pain affecting nearly two million Americans and ranging from mild discomfort to debilitating pain, it's common to see patients quite often who complain of pain where the fascia attaches to the calcaneous, or heel bone. Plantar fasciitis is a condition in which the plantar fascia becomes inflamed and painful and is the most common form of heel pain.

Once your podiatrist diagnoses plantar fasciitis, you'll report 728.71 (Plantar fascial fibromatosis), says Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Lawrenceville, Ga. Since the podiatrist may treat this condition by a variety of means, keep up with the latest treatment coding options and create a paper trail to support medical necessity at every level.

Look Out for Likely Injection Options

Your podiatrist may begin by treating the patient's plantar fasciitis conservatively with pain relievers, anti-inflammatory medication, home exercises, night splints, or rest.

Next step: If the treatment plan evolves, the podiatrist might administer a cortisone injection directly to the plantar fascia. Code this treatment with 20550 (Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar "fascia"]). You can also code for the medication, such as J0702 (Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg) for Celestone Soluspan.

Tip: Keep an eye on multiple procedures or services during the same encounter, such as an injection followed by strapping to further alleviate pain (29540, Strapping; ankle and/or foot). In most cases, the payer will likely reject 29540 with 20550, since Correct Coding Initiative (CCI) edits list 29540 as a component of 20550. If there is a separate and distinct medical reason for the strapping on the same day as the injection, append modifier 59 (Distinct procedural service) to 29540.

For some private payers, you might be able to argue that the injection and strapping provide different therapeutic effects. Before submitting both codes on your claim, check your payer's specific guidelines.

Don't Be Shocked By No Shock Wave Pay

If more conservative treatments and injections fail to relieve the patient's pain,physicians sometime successfully treat plantar fasciitis with extracorporeal shock wave therapy (ESWT).

The theory behind ESWT is that shock waves stimulate healing by promoting revascularization. If the podiatrist opts for this treatment course, report ESWT with28890 (Extracorporeal shock wave, high energy, performed by a physician, requiring anesthesia other than local, including ultrasound guidance, involving the plantar fascia).

Heads up: "Many payers deem [ESWT] an investigational procedure," says Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network in Beverly Hills, Calif. Therefore, you may not have success in getting this claim approved.

Prepare: Have clear documentation of other treatments that have failed over a period of months to help support your physician's choice of ESWT. If the payer does not cover ESWT, obtain an advance beneficiary notice from the patient prior to the procedure.

See Surgery as the Last Resort

In most cases, plantar fasciitis does not require surgical treatment to stop pain,alleviate the symptoms, or reverse damage. If all other treatments fail, however, your podiatrist might feel that the patient requires surgery. Surgical fascia release procedures fall into three categories:

endoscopic plantar fascia release (29893, Endoscopic plantar fasciotomy) open plantar fasciectomy such as 28060 (Fasciectomy, plantar fascia; partial [separate procedure]) or 28062 (... radical [separate procedure])

open plantar fasciotomy such as 28008 (Fasciotomy, foot and/or toe) or 28250 (Division of plantar fascia and muscle [e.g., Steindler stripping] [separate procedure]).

While the podiatrist may opt for an endoscopic approach in some cases, it pays to know your open codes because the open approach is more common for surgical fascia release in the treatment of plantar fasciitis. "This is probably because of concern about nerve injury if the procedure is done endoscopically," explains Bill Mallon, MD, an orthopedic surgeon and medical director of Triangle Orthopaedic Associates in Durham, N.C.

Surgeons might also opt for the open approach if they don't know exactly what will be needed during the case, Parks adds.