Podiatry Coding & Billing Alert

Question: The podiatrist performed an ultrasound to diagnose plantar fascia on a Medicare patient. It was followed by ESWT therapy. A second ultrasound was done when the ESWT therapy proved ineffective in eliminating the pain. How should I code this? Is the second ultrasound considered a follow-up study?Alaska SubscriberAnswer: For the diagnosis, code the plantar fasciitis using 728.71 (Plantar fascial fibromatosis). The ultrasound procedure should be billed as CPT 76881-76882 (Ultrasound, extremity, nonvascular, real-time with image documentation).The ESWT therapy performed would be coded as 28890 (Extracorporeal shock wave, high energy, performed by a physician, requiring anesthesia other than local, including ultrasound guidance, involving the plantar fascia).For the second ultrasound, bill 76970 (Ultrasound study follow-up [specify]). Append modifier TC (Technical component) if appropriate.