Podiatry Coding & Billing Alert

Question: Our podiatry office encountered a patient recently and the notes said that she was given extracorporeal shock wave therapy. Is there any code to capture the service? What does the procedure entail?

Alabama Subscriber

Answer: For reporting extracorporeal shock wave treatment (ESWT), you will have to visit Category III codes. As you have not specified the specific description of the therapy, you will have to choose from two available codes for this type of service. Depending upon whether the shockwaves are low energy or high energy, you can use code 0019T (Extracorporeal shock wave involving musculoskeletal system, not otherwise specified, low energy) or 0101T (Extracorporeal shock wave involving musculoskeletal system, not otherwise specified, high energy). This service treats conditions such as plantar fasciitis (PF). You should append code 728.71 (Plantar fascial fibromatosis) to the claim. You can also use another direct code for ESWT 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).

Please go through your LCD guidelines for exact payment possibilities. Some carriers differentiate between high-energy and low-energy ESWT and detail separate guiding principles for each. Your documentation must include more than just one of the possible diagnoses. It must also include documentation detailing failed previous treatment and the patient’s response to this treatment that support the patient’s need for the ESWT service. The carrier may also deny the service as non-covered and investigational, based on the lack of literature support for such treatment.

ESWT is a technique using low or high pressure sound waves that are focused on a small area to fracture small solid objects such as calcium deposits or other calculi; also known as lithotripsy or orthotripsy. Extracorporeal shock wave therapy (ESWT) is a noninvasive treatment that involves delivery of shock waves to the painful region with the objective of reducing pain and promoting healing of the affected soft tissue. The shock waves for orthopedic indications are the same as those used to break up kidney stones, but have 10 times less energy. Orthotripsy when used in a podiatric context, include localized, painful musculoskeletal conditions such as plantar fasciitis associated with calcaneus bone spurs. In this situation, ESWT serves as an alternative to surgery for patients with chronic heel pain that has not responded to conservative therapy. ESWT may also be indicated in promotion of bone healing in delayed and nonunion fractures. 

Under ICD-10, you will report M72.2 (Plantar fascial fibromatosis) for the Plantar fasciitis diagnosis.