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2004 CPT code for ESWT

Posted by Donna R on 5/10/04 at 21:26 (150378)

I've searched the internet for a CPT code for ESWT for plantar fascitis and am unable to find an appropriate code. The only one I came up with is 0020T which is temporary code. I'm in Rhode Island and don't think the Blue Cross/Blue Shield will accept this code.

Can any podiatrist or billing manager assist me?

Thank you!

Re: 2004 CPT code for ESWT

Pauline on 5/11/04 at 10:16 (150398)

There was a similar question recently, only it was in PA.

I will post Dr.Ed's response to that posters inquire.

Re: ESWT Reimbursement view thread
Posted by Ed Davis, DPM on 5/04/04 at 22:27

When researching coverage, we generally do so by procedure code and the procedure code for ESWT is 0020T.

I was able to give Marc a phone number and physicians name that uses ESWT as a resourse, in his own state of PA, which happened to be a prominent Orthopedic and Sports Medicine group.

You may want to do the same through your local phone directory. If any of them are billing for ESWT and using a different code than the one that you found or Dr. Ed posted, they should be able to give it to you.

Re: 2004 CPT code for ESWT

Ed Davis, DPM on 5/11/04 at 15:12 (150412)

Donna and Pauline:
There still is only the 'temporary' code 0020T. How do the individuals who sit on the CPT committee decide which procedures are to have permanent codes, let alone codes at all? There is no CPT code for orthotics or to accurately describe the process in constructing them. Sometimes, lack of accurate coding is an invitation for ambiguity. The ICD9 codes are codes for diagnoses. Beleive it or not there is NO SPECIFIC CODE FOR PLANTAR FASCIITIS. Fairly hard to beleive when one considers how common PF is! The ICD9 code 729.4 is a general code for 'fasciitis' and the code 728.71 is a code for plantar fibromatosis, specifically. It is sometimes used as a 'substitute' code for PF but it is not the specific code.

Re: 2004 CPT code for ESWT

Pauline on 5/11/04 at 15:25 (150414)

Dr. Ed.
Thank you for the explaination. Would these codes hold true for all the states or do they vary depending on the state you live in, and then change again within that state by the city and county that you live in?

Re: 2004 CPT code for ESWT

Ed Davis, DPM on 5/11/04 at 15:40 (150415)

They are national codes. In fact, the CPT codes are proprietary to the AMA.

Addendum: There are 'additional' codes: 1)HCPCS codes -- generally used to describe supplies and orthotics; 2)'local' codes -- an exception to the rule we discussed above -- these are codes that are created for use by a local carrier. A carrier may feel that a different or more specific description is needed for a specific service.

Re: 2004 CPT code for ESWT

Scott D. on 5/12/04 at 08:49 (150454)

ICD-9's are international codes (International Classification of Diseases) and based upon the published ICD-9 codes of the World Health Organization.

Re: 2004 CPT code for ESWT

MARK L on 5/12/04 at 20:16 (150490)

Try billing using 28899. United Healthcare has paid with this code. Others will pay with 0020T or a combination of both.

Re: 2004 CPT code for ESWT

Ed Davis, DPM on 5/13/04 at 19:53 (150542)

That is a code for an 'unlisted' procedure. Nothing wrong with using it if United prefers it. Often, use of 'unisted' procedure codes does invite a time delay in payment.