People get engaged in sports activities to maintain an active and healthy life. However, it can be a common source of injury. Generally, injuries are of different types which occur 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 is one such overuse injury of the achilles tendon – the band of tissues that directly connects the calf muscles at the back of the lower leg to your heel bone or calcaneus. It most commonly occurs in runners who have suddenly increased the intensity or duration of their runs. It also occurs in middle-aged people who engage in sports activities like tennis or basket ball. If left untreated, the injury can make the tendons to tear or rupture. In mild cases, treatment may involve resting or changing an exercise routine, but more severe cases may require surgical repair. Orthopedic medical billing and coding to document such injuries can be time-consuming and challenging. Outsourcing all or part of the medical billing and coding tasks would allow practitioners to focus on their work without worrying about the documentation process.

Types and Causes of Achilles Tendinitis

Generally, Achilles tendinitis can develop in different ways. Some cases of tendinitis are easier to avoid, and diagnosing the condition at an early stage can help prevent serious injury. Achilles tendinitis is of two different types – insertional and non-insertional Achilles tendinitis.

  • Insertional Achilles tendinitis – This type of 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 – More common in young, active people, the condition involves fibers in the middle portion of the tendon starting to break down, thicken, and swell.
     
    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). Other related causes 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
    • 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
    • Having bone spurs in the back of your heels

Achilles Tendinitis Symptoms

Pain and swelling that begin as a mild ache at the backside of the leg or above the heel (after running or other sports activity) is one of the main symptoms associated with the condition. In addition, people may also experience tenderness or stiffness, especially in the morning, which usually improves with mild activity. Other related symptoms include –

  • Discomfort or swelling in the back of the heel
  • Tight calf muscles
  • Limited range of motion when flexing the foot
  • Skin on the heel overly warm to the touch

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 (certain types of antibiotics called fluoroquinolones).

Diagnosing and Treating Achilles Tendinitis

Diagnosis of this condition generally begins with a detailed medical history evaluation by the physician. Patients will be asked about the pain and swelling in the heels or calf. A detailed physical examination will also be performed wherein the physician will gently press on the affected area to determine the location of 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 (that detect ruptures and tissue degeneration) and Ultrasounds (to analyze tendon movement) that help rule out other possible causes of pain and swelling and to assess any damage to the tendon.

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

Orthopedic medical coding involves using the specific ICD-10 diagnosis codes to report various orthopedic conditions such as Achilles tendon on the medical claims. Medical billing and coding services are available for orthopedists to help with timely documentation and claim submission.
ICD-10 diagnosis codes for achilles tendon include –

  • M76.6 Achilles tendinitis
  • M76.60 Achilles tendinitis, unspecified leg
  • M76.61 Achilles tendinitis, right leg
  • M76.62 Achilles tendinitis, left leg

The common complications associated with Achilles tendonitis is pain, having trouble walking or exercising, and the tendon or heel bone becoming deformed. Tendinitis usually goes away after a few days, following rest and proper home treatment (including the RICE method). However, recovery may take a longer time 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 help prevent the occurrence of Achilles tendinitis in the long run.

As orthopedic medical billing and coding is challenging and time-consuming, physicians can consider hiring medical coding services. This would ensure accurate reporting of diagnostic details and help avoid delayed / denied claims.