Wiki Plantar fascia injection under U/S Guidance

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lcole7465

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The provider I code for performed this procedure on a patient snip of note below:

The area over the medial malleolus was cleaned with chlorhexidine in a sterile fashion. We then used ultrasound guidance in order to identify the medial malleolus, as well as the left plantar fascia. We then advanced a 27-gauge needle towards the posterior tibial nerve under ultrasound guidance. Once the needle tip entered the sheath of the nerve, there was negative aspiration and negative parethesia. We injected a total of 4mL Lidocaine 1% with 40 mg of Depo-Medrol.

He wants to use CPT 64455. But everything I'm finding is leading towards 20550 for a plantar fasciitis injection. From what I'm reading is 64455 is for Morton's neuroma.

Thanks in advance.
 
lcole7465 said:
The provider I code for performed this procedure on a patient snip of note below:

The area over the medial malleolus was cleaned with chlorhexidine in a sterile fashion. We then used ultrasound guidance in order to identify the medial malleolus, as well as the left plantar fascia. We then advanced a 27-gauge needle towards the posterior tibial nerve under ultrasound guidance. Once the needle tip entered the sheath of the nerve, there was negative aspiration and negative parethesia. We injected a total of 4mL Lidocaine 1% with 40 mg of Depo-Medrol.

He wants to use CPT 64455. But everything I'm finding is leading towards 20550 for a plantar fasciitis injection. From what I'm reading is 64455 is for Morton's neuroma.

Thanks in advance.
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What is the diagnosis for this procedure?
 
What is the correct way to bill for an injection of the plantar fascia?

AMA Comment:

The plantar fascia is considered an aponeurosis that extends from the calcaneal tuberosity distally to the forefoot. The descriptor for code 20550 has been revised for CPT 2004 and now reads 20550, Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia"). Therefore, code 20550 would be the appropriate code to use for reporting an injection of the plantar fascia.
 
I disagree with the above. Based on the dictation the provider injected the sheath of the nerve not the tendon. 20550 is not for nerve injections.

I see why your provider is leaning towards 64455 Injection(s), anesthetic agent(s) and/or steroid; plantar common digital nerve(s) (eg, Morton's neuroma).
 
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