A Closer Look At Practice Management Aspects Of Treating Heel Pain

Author(s): 
By Lowell Weil Jr., DPM, MBA

Key Treatment And Coding Tips For Conservative Management
After diagnosing plantar fasciitis, one should recommend and institute a treatment plan. I have found that a detailed but simple explanation of the etiology of the problem to the patient makes his or her compliance to the solution more likely. Initially, higher heeled shoes are recommended to relax the tight calf muscle complex, which is a common contribution to the development of heel pain. Any shoe that has at least a one-inch differential from the heel to the toe is beneficial. However, it has been our experience that running shoes provide the greatest support and comfort.
Furthermore, patients should avoid going barefoot or wearing slippers, flats, sandals, house shoes or any other type of foot gear that does not offer heel height or support. Several companies offer physicians the opportunities to provide these types of shoe gear options through their offices. These services help assure patients they are purchasing the proper shoes and there is tremendous convenience as patients do not have to go out searching for the proper shoe.
Studies have shown that it is best to treat plantar fasciitis with an “arch support” of some sort. Initially, we utilize an over-the-counter device that we always customize for the patient at the time of initial visit, thereby starting the healing process immediately. There are many devices available on the market that are effective and one can easily customize these in the office by simply grinding the device or adding modifications to the device. When providing this service, you would code it as L3060 for both the left and right foot. While some insurance companies like Medicare do not cover this code, many others will reimburse for this service in the $75 to $150 range.
Addressing the tight calf muscle complex is crucial to successfully treating plantar fasciitis. We commonly refer the patient to our physical therapists or prescribe physical therapy to help train patients on proper stretching techniques, and then monitor their compliance over a span of time. Additionally, researchers have found night splints to be effective for treating chronic plantar fasciitis. One would code the night splints with L1930, which is commonly reimbursed by insurance companies.
Using antiinflammatory medications is very effective in reducing swelling and pain associated with this condition. Breaking the pain cycle of this problem is key to getting the patient moving toward recovery.
In many circumstances, over-the-counter or semi-custom arch supports are not sufficient to properly support and control the patient’s biomechanical problems. In those cases, customized orthotics are very valuable. When it comes to patients with heel pain, we have found that softer, accommodative orthotics have greater success and compliance with our patients than the more typical, plastic, functional devices.
The accommodative devices that we utilize for heel pain are produced by The FootCare Depot (footcaredepot@gmail.com). The FootCare Depot’s high medial and lateral phlange (UCB type) offers more support and control of the foot. One would code these devices with L3000, which offers a higher reimbursement than standard orthotics that one would commonly code as L3020. When billing for orthotics, it is important to bill for both the left and right device individually.

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