Take The Pain out of Coding Heel Spur Diagnoses
Can you code heel spurs and plantar fasciitis together? Calcaneal spurs, or heel spurs as they’re commonly known, are bony growths on the calcaneus (heel bone). Podiatrists diagnose and treat these conditions, but do you know how to identify the correct codes for the spurs or what to report if spurs are ruled out? Revenue Cycle Insider put together the following guide to alleviate your calcaneal spur coding confusion. Know What Heel Spurs Are Heel spurs are bony growths that develop on the plantar surface of the heel and can occur due to chronic traction and strain on the plantar fascia and nearby ligaments. Heel spurs are usually associated with plantar fasciitis, overuse, obesity, and wearing high heels. Patients may not experience any symptoms at all (asymptomatic) or could feel pain when bearing weight on the affected foot, tenderness at the plantar calcaneus, and heel pain that’s usually worse first thing in the morning. Dive Into Diagnostic Testing Podiatrists take several steps to diagnose or rule out suspected heel spurs. Upon the first visit to the practice, the physician will collect a patient history and information about the patient’s activity level and chronic heel pain. The podiatrist will also perform a physical examination to check for tenderness in the heel as well as observe how the patient walks. If the podiatrist suspects spurs, they’ll order X-rays, such as 73650 (Radiologic examination; calcaneus, minimum of 2 views), that will confirm or rule out the presence of a projection from the heel bone. However, MRI and ultrasound may be needed to examine soft tissue damage if the X-rays do not show bony abnormalities. Assign the Correct ICD-10-CM Codes Codes for heel spurs are located in the M77.3- (Calcaneal spur) code subcategory in the ICD-10-CM code set. Open the Alphabetic Index and search for Spur, bone > calcaneal to locate M77.3-. You’ll then turn to the Tabular List to verify the correct five-character code or codes for the diagnosis. The heel spur codes are as follows: You won’t use any of the above M77.3- codes on your claim unless the podiatrist has documented a definitive calcaneal spur diagnosis. If the provider reviews the images and determines that the patient is experiencing plantar fasciitis instead of heel spurs, you’ll use M72.2 (Plantar fascial fibromatosis) as the diagnosis code. However, if the podiatrist rules out heel spurs and plantar fasciitis and deems that additional imaging is required, you’ll assign codes that represent the documented signs/symptoms. Examples of symptom codes include: Caution: Make sure to double-check the physician’s documentation, so you don’t make errors that could result in a denial. Don’t use the unspecified heel spur code (M77.30) when the documentation specifies the condition is occurring in both feet or either the right or left foot. Another common mistake is assigning heel spur codes when only heel pain is documented. Lastly, if the physician documents the patient is experiencing plantar fasciitis due to the calcaneal spurs, make sure to avoid using M72.2 as the primary diagnosis code. Test Your Coding Knowledge Scenario: A 55-year-old new patient presents to a podiatrist with chronic right heel pain worsening over six months. A physical exam reveals point tenderness at the plantar aspect of the right calcaneus. The podiatrist orders a three-view X-ray of the right heel, which confirms a calcaneal spur. The provider documents “right foot calcaneal spur and associated plantar fasciitis.” In this scenario, the imaging confirmed a heel spur in the right foot, which was documented in the patient record. The physician also documented that the patient’s coexisting plantar fasciitis was due to the calcaneal spurs, and this means the condition can be reported separately. For this scenario, you’ll assign M77.31 to report the heel spur in the right foot. You’ll also use M72.2 to report the associated plantar fasciitis. Mike Shaughnessy, BA, CPC, Production Editor, AAPC
