Podiatry Coding & Billing Alert

Hint: Report the appropriate J-codes along with 20551 for an injection.

Your podiatrist diagnoses a patient with a heel spur. As you are reading through the medical documentation for the case, you must know the exact location of the heel spur. You should also understand what a heel spur is.

Read on to learn more.

First, Define Heel Spurs for Clarity

Heel spurs, also called calcaneal spurs, may be caused by tears in the origin of the plantar fascia at the calcaneus. Due to excessive use or microtrauma, the plantar fascia may tear at its origin on the heel bone. If adequate healing does not occur, calcium deposits may collect to form an exostosis or protrusion, which creates a heel spur.

ICD-10 gives you the following diagnosis codes for heel spurs:

• M77.30 (Calcaneal spur, unspecified foot)
• M77.31 (Calcaneal spur, right foot)
• M77.32 (Calcaneal spur, left foot).

Coding example: Your podiatrist diagnoses Mr. Smith with a heel spur in his right foot. You should report M77.31 as the diagnosis code on this claim.

Clue Into 3 Treatment Options for Heel Spurs

When your podiatrist treats a heel spur, you are likely to see one of the following treatment options in the medical documentation:

Scenario 1: The patient has a heel spur in his left foot. The podiatrist performs an ostectomy, calcaneus for spur, with a plantar fascial release to excise the spur. You should report 28119 (Ostectomy, calcaneus; for spur, with or without plantar fascial release) and M77.32 (Calcaneal spur, left foot) on your claim.

Don’t miss: You should report 28119 regardless of whether the podiatrist makes release incisions on the stressed or irritated plantar fascia.

Scenario 2: The patient has a heel spur on his right foot. The podiatrist excises the spur and removes a part of the calcaneus. You should report 28118 (Ostectomy, calcaneus) and M77.31 on your claim.

Notice: This is a prime example of why reading the medical documentation closely is so important. You should only report 28118 if the podiatrist excises a heel spur, along with removing a part of the calcaneus.

Scenario 3: The podiatrist gives the patient a corticosteroid injection in his left foot to reduce the inflammation caused by a heel spur. This injection includes both the plantar fascia and the area around the heel spur. You should report 20551 (Injection(s); single tendon origin/insertion) for the injection, along with the appropriate J-codes. However, for the units on your claim, make sure that you only report one injection, says Arnold Beresh, DPM, CPC, CSFAC, in West Bloomfield, Michigan. For the diagnosis code, you should report M77.32.

Investigate Documentation for Cast Application

When your podiatrist performs a heel spur excision, you should check the medical documentation to see if he also applied a walking cast at the time of the heel spur surgery. Keep in mind that the first cast applied at the time of surgery is a part of the global package. However, you may report subsequent casts, if any. For instance, for a short leg cast, you would report 29425 (Application of short leg cast (below knee to toes); walking or ambulatory type).

Don’t miss: A change of cast in the global period requires you to confirm if there was a cause for the change. For example, if your podiatrist had to change the cast due to a pressure ulcer. In this case, you should report 29425 for the cast and append modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period) to the cast application code. In this case, you would also report the appropriate diagnosis cods, depending upon where the pressure ulcer is located. For example, some of these codes include L89.5- (Pressure ulcer of ankle …), L89.6- (Pressure ulcer of heel …), or L89.89- (Pressure ulcer of other site …).