Keep Coding Grounded for Gastrocnemius Recession
Check your state’s scope-of-practice requirements for podiatrists allowed to treat gastrocnemius equinus.
By Angela Clements, CPC, COSC
A change in the scope of practice for podiatric physicians in Louisiana now allows for above-the-ankle treatment—making the Pelican State the 44th state to permit podiatrists to treat at or above the ankle. For patients, the wider scope of practice means not having to be referred to a surgeon for certain treatments, such as a gastrocnemius recession to correct a foot deformity. For podiatrists, it means expansion and growth, but also added responsibility. In particular, podiatrists must know how to document such treatments to ensure compliant coding.
Treating Gastrocnemius Equinus
A gastrocnemius recession is performed on a patient with gastrocnemius equinus (tightness of the calf muscle) to lengthen the calf muscle. The tightness in the gastrocnemius muscle causes the ankle to point downward, meaning the joint cannot dorsiflex (bend up) normally. Gastrocnemius recession lengthens the calf muscle to get the heel on the ground.
When a patient has gastrocnemius equinus, the physician checks the ankle’s range of motion with the knee in the bent (flexed) and straight positions. If the patient can normally flex the ankle when in a bent position, a gastrocnemius recession would be indicated. If the patient cannot flex the ankle when the knee is either bent or straight, he or she will have to lengthen the Achilles tendon, 27685 Lengthening or shortening of tendon, leg or ankle; single tendon (separate procedure), or look for a bony block (spur), 28120 Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); talus or calcaneus.
The problem with lengthening the Achilles tendon is that it weakens the plantar flexion strength. Podiatrists prefer not to lengthen the Achilles if other options are available to maintain muscle strength.
Gastrocnemius Recession Techniques Advance
Gastrocnemius recession traditionally has been (and sometimes still is) performed as an “open” procedure using a T-shaped incision (some surgeons perform the procedure with a reverse T-shaped incision). Reporting an open gastrocnemius recession is straightforward: 27687 Gastrocnemius recession (eg, Strayer procedure) properly describes the procedure.
As medicine advances, so have treatment options for the gastrocnemius recession procedure. A scope similar to the one used for carpal tunnel endoscopic surgery was developed for an endoscopic gastrocnemius recession (EGR). This scope allows surgeons to perform the procedure endoscopically, with smaller incisions.
The surgeon cuts through the fascia to expose the underlying muscle. The gastrocnemius is separated from the soleus muscle and a gap is left in the fascial segments to lengthen it. Compared to an open procedure, endoscopic surgery is minimally invasive, which allows for a quicker recovery time. The patient can bear weight in a cast boot.
There isn’t a specific CPT® code to report EGR, so you must report the procedure using 29999 Unlisted procedure, arthroscopy. Coders often hesitate to use this code because of the wording of its descriptor (i.e., the use of “arthroscopy” rather than “endoscopy”). The November 2008 CPT® Assistant clarified that this unlisted code is appropriate, however, stating:
“There is no specific CPT® code to describe endoscopic gastrocnemius recession. This procedure should be reported using code 29999 … While code 29999 uses the term ‘arthroscopic’ and the joint space is not entered, code 29999 is located in the section for arthroscopic or endoscopic procedures of the musculoskeletal system and is intended to include unlisted endoscopic services.”
Tip: To claim endoscopic plantar fasciotomy, another common podiatric endoscopic procedure, report 29893 Endoscopic plantar fasciotomy.
Although most states now allow podiatrists to treat above-the-ankle, some states do not. Be sure to consult your state’s scope-of-practice requirements before making the leap into gastrocnemius recession.
Author’s note: Special thanks to Daniel Hake, DPM, for assisting with the clinical information in this article.
Angela Clements, CPC, COSC, is an internal consultant in the Coding and Education Department at Ochsner Health Systems in New Orleans. With 15 years of healthcare experience, she is also a member of the AAPC National Advisory Board and member development officer in the local Covington, La., chapter