Coding Achilles Tendinitis

0:00 – Hello everyone and welcome to our podcast series.  My name is Natalie Tornese and I’m the Senior Group Manager for Outsource Strategies International. I wanted to take this opportunity to go over Achilles Tendinitis.

0:13 – Achilles Tendinitis – Introduction

A common source of injury when engaging in sports and activities is Achilles tendinitis which occurs as a result of repetitive movements caused by over-stretching of the muscles and ligaments, poor training practices, collisions, sudden movements, improper use of equipment and changes in direction. Achilles tendinitis happens when–the band of tissues that directly connects the calf muscles at the back of the lower leg to your heel bone or calcaneus become affected. It most commonly occurs in runners who have suddenly increased the intensity or duration of their runs. It also can occur in middle-aged people who engage in sports activities like tennis or basketball. If left untreated, the injury can make the tendons to tear or rupture. In many cases, treatment may involve resting or changing an exercise routine, but more severe cases may require a surgical repair.

1:09 – Types of Achilles Tendinitis   

Generally, Achilles tendinitis can develop in different ways. Diagnosing the condition at an early stage can help prevent serious injury. There are two different types of Achilles tendinitis, one called insertional and the other is non-insertional. Insertional tendinitis affects the lower portion of the tendon where it attaches to the heel bone. The condition is not necessarily related to activity. Non-insertional Achilles tendinitis is more common in young, active people. The condition involves fibers in the middle portion of the tendon. These fibers start to break down, thicken, and swell.

 1:46 – Causes of Achilles Tendinitis  

Any repeated or intense activity that strains the Achilles tendon can potentially cause tendonitis. As people age, the structure of the tendon weakens which makes it more susceptible to injury (particularly in people who have increased the intensity of their sports activities). There are other related causes which include – exercising without proper warm-up, straining the calf muscles (during repeated exercise or physical activity), wearing old or poorly fitting shoes, wearing high heels daily or for prolonged durations, a sudden increase in physical activity (without allowing your body to adjust to increased training), running on hard or uneven surfaces, playing sports such as tennis that require quick stops and changes of direction or having bone spurs in the back of your heels.

2:38 – Signs and Symptoms

The symptoms are pain and swelling that begin as a mild ache usually at the backside of the leg or above the heel (after running or any other sports activity). This is one of the main symptoms associated with the condition. Additionally, people may also experience a tenderness or stiffness, especially in the morning, which usually improves with mild activity throughout the day. Other related symptoms include discomfort or swelling in the back of the heel, tight calf muscles, limited range of motion when flexing the foot and the skin on the heel may feel overly warm to the touch.

3:15 – Risk factors

A number of factors can increase the risk of this condition, which include age, medical conditions (like psoriasis or high blood pressure), physical problems (like obesity and tight calf muscles), incorrect training choices, and use of certain medications (like certain types of antibiotics).

3:35 – Diagnosis of Achilles Tendinitis

Diagnosing this condition generally begins with a detailed medical history evaluation by the physician. Patients will be asked about pain and swelling in the heels or calf. A detailed physical exam will also be performed wherein the physician will gently press on the affected area to determine the location of the pain, tenderness or swelling. Orthopedists may also ask patients to stand on the balls of their feet while observing their range of motion, alignment and flexibility of the foot and ankle. They may also perform imaging tests like X-rays, magnetic resonance imaging (MRI) scans, and ultrasound which can help rule out other possible causes of pain and swelling and to assess any damage to the tendon.

4:19 – Treatment of Achilles Tendinitis

Treatment modalities for this condition can range from self-care strategies like rest and anti-inflammatory medications, to more invasive treatments like steroid injections, platelet-rich plasma (PRP) injections, and surgery. In most cases, the RICE method – which is comprised of rest, ice, compression, and elevation – is usually effective in treating it right after the tendon gets injured. Orthopedists may also suggest medications (like over-the-counter medications like ibuprofen (Advil, Motrin IB, others) or naproxen), or physical therapy exercises is helpful like stretching and strengthening), and orthotic devices to relieve strain on the tendon. If any of these conservative treatment modalities don’t yield the desired results or if the tendon has torn, surgery may be recommended to repair the tendon.

I will include a transcript along with this podcast outlining the specific ICD-10 codes associated with this condition.

5:17 – Common Complications of Achilles tendonitis

The common complications associated with Achilles tendonitis is pain, having trouble walking or exercising, and the tendon or heel bone becoming deformed. Tendinitis will usually go away after a few days, following rest and proper home treatment. However, recovery may take longer if the patient continues to put pressure on the tendon or doesn’t change exercise habits to prevent another injury or rupture. Seeking proper treatment for the ruptured tendon is very important. In addition, carefully following the physician’s instructions will give patients a much better chance for a quick recovery. Incorporating certain self-care strategies like stretching the calf muscles, combining high- and low-impact exercises, choosing shoes with proper cushioning and arch support, and reducing the heel size of the shoes can prevent the occurrence of Achilles tendinitis in the long run.

I hope this helps but  always remember that documentation and a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.