Hello, RichMan.
Yes. It is possible. You can paint images inside Blender, so you can make heightmaps by even painting directly to a mesh. Here is a fun way to do it:
1. Create a mesh with as many subdivisions as you need;
2. Create a new image in the image panel;
3. Make a UV Map for the mesh;
4. Add to the mesh the modifier "displacement map". Use the image you created as heightmap;
5. Go to body painting mode and use white brush with the texture, size, mode, intensity that you need.
You can also paint the height map in the image editor panel, if your PC is too slow to process 3D painting on a dense mesh.
You may also use the mesh sculpting tools to make the details, bake the tangent space normal map (new feature in the Blender CVS) and convert it to height map. I am not sure about how you can do that, but I guess that it is possible.
Have fun.