How To Use CPT Code 28261

CPT 28261 describes a surgical procedure that involves the incision of the capsule enclosing the talonavicular joint and the lengthening of a tendon in patients with clubfoot, a congenital deformity. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 28261?

CPT 28261 is a code used to describe a surgical procedure performed on patients with clubfoot, a congenital deformity characterized by severely twisted feet. The procedure involves making an incision in the capsule that encloses the talonavicular joint and lengthening a tendon. This surgical intervention aims to correct the deformity and improve the patient’s mobility and function.

2. Official Description

The official description of CPT code 28261 is: ‘Capsulotomy, midfoot; with tendon lengthening.’

3. Procedure

1. After appropriate patient preparation and anesthesia, the healthcare provider makes a medial ankle incision.
2. The provider then incises the subcutaneous tissue and fascia, allowing access to the tendons and the joint capsule.
3. Using sharp instruments, the provider carefully incises the joint capsule to release tension on the midfoot.
4. A tenotomy is performed, which involves incising the tendon in a Z fashion to lengthen it.
5. The provider irrigates the area, checks for bleeding, removes any instruments, and closes the incision.
6. To maintain the corrected position, an above-knee cast is applied with the foot slightly pointed downward.

4. Qualifying circumstances

CPT 28261 is performed on patients with clubfoot, a congenital condition characterized by severely twisted feet. The procedure is indicated when conservative treatments, such as physical therapy and bracing, have failed to correct the deformity. It is important to note that this procedure should only be performed by qualified healthcare professionals with expertise in foot and ankle surgery.

5. When to use CPT code 28261

CPT code 28261 should be used when a healthcare provider performs a capsulotomy and tendon lengthening procedure on a patient with clubfoot. It is important to ensure that the patient meets the qualifying circumstances for this procedure and that conservative treatments have been unsuccessful in correcting the deformity.

6. Documentation requirements

To support a claim for CPT code 28261, the healthcare provider must document the following information:

• Patient’s diagnosis of clubfoot
• Details of the surgical procedure performed, including the incision site, capsule incision, and tendon lengthening
• Any additional procedures or interventions performed during the same surgical session
• Postoperative care instructions and follow-up plans
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 28261, it is important to ensure that the procedure was performed by a qualified healthcare professional and that the documentation supports the medical necessity of the procedure. It is also important to follow any specific billing guidelines provided by the payer. Additionally, it is important to note that CPT code 28261 should not be reported with other codes that describe similar procedures or services.

8. Historical information

CPT code 28261 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A healthcare provider performs a capsulotomy and tendon lengthening procedure on a newborn with severe clubfoot deformity.
2. A patient with untreated clubfoot undergoes a capsulotomy and tendon lengthening procedure to correct the deformity and improve mobility.
3. A teenager with persistent clubfoot deformity undergoes a capsulotomy and tendon lengthening procedure to improve foot alignment and function.
4. A young adult with recurrent clubfoot deformity undergoes a capsulotomy and tendon lengthening procedure to address the ongoing foot misalignment.
5. An elderly patient with long-standing clubfoot deformity undergoes a capsulotomy and tendon lengthening procedure to alleviate pain and improve mobility.