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Thread: Help with plantar fasciitis

  1. #1

    Default Help with plantar fasciitis

    AAPC: Back to School
    For the case below I am wondering if I can code both 28008 (fasciotomy) and 28119 for the heel spur excision. The physician indicates both procedures but the code 28119 is for ostectomy, calcaneus which in reading the report I'm not sure the bone spur was removed or just smoothed down?

    Help...Thank you

    POSTOPERATIVE DIAGNOSES: Heel spur and plantar fasciitis, left foot.

    1. Excision of heel spur, left foot.
    2. Plantar fasciotomy, left foot.


    MATERIALS: 3-0 nylon.

    INJECTABLES: 10 cc of 0.5% Marcaine preoperatively and 10 cc of 1% lidocaine intraoperatively.

    DRESSINGS: Xeroform, fluffs, Kerlix and Ace wrap.


    PROCEDURE IN DETAIL: The patient brought into the operative room and placed on the operating table in a supine position where IV sedation was administered. A 10 cc of 0.5% Marcaine plain was infiltrated into the left foot for adequate local anesthesia. The left foot was prepped and draped in the usual standard aseptic fashion. Upon exsanguination, the left pneumatic ankle tourniquet was inflated to 250 mmHg. Attention was then directed to the plantar medial aspect of the left heel where a linear incision was made at the plantar fascial insertion to the calcaneus. This incision was deepened bluntly to the level of plantar fascia. The soft tissue was freed superiorly and inferiorly from the plantar fascia. A Smillie knife was then used to resect the medial two-thirds of the plantar fascia. A surgical rasp was then used to rasp the heel spur smooth. This was confirmed using FluoroScan intraoperatively. Satisfied that the patient’s pathology had been addressed, the wound was copiously lavaged using saline. The surgical wound was then re-approximated using 3-0 nylon. 1 cc of dexamethasone was infiltrated postoperatively and the surgical wound was then dressed using Xeroform, fluffs, Kerlix and an Ace wrap. The patient tolerated both the anesthesia and procedure well and was transported from the operating room to the recovery room with vital signs stable and vascular status intact to the left foot.

  2. #2

    Default Heel spur and plantar fascitis

    I have 12 years of podiatry coding experience. The code you will be utilizing is 28119 (Ostectomy, calcaneus; for spur, with or without plantar fascial release). 28008 (Fasciotomy, foot and/or toe) is a component of 28119 therefore not billable. Let me explain: Spur formation is an indication that there is too much tension being placed on the plantar fascia which originates at the calcaneous. The plantar fascia might have torn away from the bone causing the patient pain. Due to this strain/sprain the body creates more bone in an effort to stabilize the area, an accomodative response to the plantar fascial stress.

    When the physician performs a 28119 he has to cut away some of the plantar fascia 28008 to get at the spur to rasp it smooth.

    I hope that I have been helpful to you.

    Lisa Brodner, R.N., CPC

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