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Medical Policy: 06.01.04
Original Effective Date: June 2004
Reviewed: October 2007
Revised:
This policy applies to all products unless specific contract
limitations, exclusions or exceptions apply. Please refer to the member's coverage
manual for benefit availability. Managed care guidelines related to referral authorization,
and precertification of inpatient hospitalization, home health, home infusion and
hospice services apply.
Description:
Plantar fasciitis is a very common ailment characterized by deep pain in the plantar aspect of the heel, particularly on arising from bed. While the pain may subside with activity, in some patients the pain may persist, interrupting activities of daily living. On physical examination, firm pressure will elicit a tender spot over the medial tubercle of the calcaneus. The exact etiology of plantar fasciitis is unclear, although repetitive injury is suspected. Heel spurs are a common associated finding, although it has never been proven that heel spurs cause the pain. It should be noted that asymptomatic heel spurs are found in up to 10% of the population.
The use of diagnostic ultrasound, or ultrasonography, has been investigated as an imaging tool to confirm the diagnosis of plantar fasciitis. Normally in the vast majority of cases the diagnosis can be made based on a thorough history and physical examination without the need for more elaborate and expensive diagnostic testing. However, for those patients who fail to respond to conventional therapy, diagnostic ultrasound may be needed to establish a differential diagnosis and eliminate the need for more costly magnetic resonance imaging.
Policy:
The use of diagnostic ultrasound to confirm or rule out a presumptive diagnosis of plantar fasciitis may be considered medically necessary when all of the following criteria are met;
- The patient has been treated with conservative therapy for a period of four weeks or more and has failed to respond. Conservative therapy consists of;
- Strapping, or
- Temporary orthotics, and
- Antiinflammatory drugs, and
- Physical therapy or physical medicine modalities
- Diagnostic ultrasound is used only once per episode of treatment after the interventions noted above.
The use of diagnostic ultrasound for routine or initial diagnosis of plantar fasciitis is considered not medically necessary, unless the above criteria are met.
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Procedure Codes and Billing
Guidelines:
- To report provider services, use appropriate CPT* codes, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD-9-CM diagnostic codes.
- CPT code 76880; Ultrasound, extremity, non-vascular, B-scan and/real time with image documentation.
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Selected References:
- Wall JR, Harkness MA, Crawford A. Ultrasound diagnosis of plantar fasciitis. Foot Ankle. 1993 Oct;14(8):465-70.
- DiMarcangelo MT, Yu TC. Diagnostic imaging of heel pain and plantar fasciitis. Clin Podiatr Med Surg. 1997 Apr;14(2):281-301.
- Gibbon WW, Long G. Ultrasound of the plantar aponeurosis (fascia). Skeletal Radiol. 1999 Jan;28(1):21-6.
- Kane D, Greaney T, Shanahan M, et al. The role of ultrasonography in the diagnosis and management of idiopathic plantar fasciitis. Rheumatology (Oxford). 2001 Sep;40(9):1002-8.
- Vohra PK, Kincaid BR, Japour CJ, Sobel E. Ultrasonographic evaluation of plantar fascia bands. A retrospective study of 211 symptomatic feet. J Am Podiatr Med Assoc. 2002 Sep;92(8):444-9.
- Buchbinder R. Clinical practice. Plantar Fasciitis. N Engl J Med. 2004 May 20;350(21):2159-66.
- American College of Radiology Appropriateness CriteriaTM for chronic foot pain. Updated 2002. Available from the National Guideline Clearinghouse.
- Ozdemir H, Yilmaz E, et al. Sonographic evaluation of plantar fasciitis and relation to body mass index. Eur J Radiol. 2005 Jun;54(3):443-7. (Abstract viewed on-line.)
- Sabir N, Demirlenk S, et al. Clinical utility of sonography in diagnosing plantar fasciitis. J Ultrasound Med. 2005 Aug;24(8):1041-8. (Abstract viewed on-line.)
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New information or technology that would be relevant for Wellmark to consider when this policy is next reviewed may be submitted to:
Wellmark Blue Cross and Blue Shield
Medical Policy Analyst
Station 304
636 Grand Ave
Des Moines, Iowa 50309
*Current Procedural Terminology © 2008 American Medical Association. All Rights Reserved.
Wellmark medical policies address the complex issue
of technology assessment of new and emerging treatments, devices,
drugs, etc. They are developed to
assist in administering plan benefits and constitute neither offers of
coverage nor medical advice. Wellmark medical policies contain only a
partial, general description of plan or program benefits and do not
constitute a contract. Wellmark does not provide health care services
and, therefore, cannot guarantee any results or outcomes.
Participating providers are independent contractors in private
practice and are neither employees nor agents of Wellmark or its
affiliates. Treating providers are solely responsible for medical
advice and treatment of members. Our medical policies may be updated
and therefore are subject to change without notice.
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