How To Use CPT Code 28264

CPT 28264 describes a surgical procedure performed on the foot to increase range of motion and release joint contracture. 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 28264?

CPT 28264 is used to describe a surgical procedure that involves incising the capsule of a midtarsal joint in the foot. The purpose of this procedure is to increase the range of motion and release joint contracture. The provider makes an incision over the base of the metatarsals and dissects the ligament to expose the intermetatarsal space. The dorsal capsule of the tarsometatarsal joints is then divided at the bases of the metatarsals. This procedure is performed to treat resistant contractures of the foot.

2. Official Description

The official description of CPT code 28264 is: ‘Capsulotomy, midtarsal (eg, Heyman type procedure).’ This procedure involves incising the capsule of a midtarsal joint in the foot to increase range of motion and release joint contracture.

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. The provider makes a dorsal transverse incision over the base of the metatarsals.
3. The ligament is dissected to expose the intermetatarsal space.
4. The provider divides the dorsal capsule of the tarsometatarsal joints at the bases of the metatarsals.
5. Motion in the joints is evaluated.
6. The area is irrigated, bleeding is checked, instruments are removed, and the incision is closed.
7. A cast is applied.

4. Qualifying circumstances

CPT 28264 is performed on patients with resistant contractures of the foot. It is used to increase range of motion and release joint contracture. The procedure is typically performed by a qualified healthcare provider who has the necessary expertise in foot surgery.

5. When to use CPT code 28264

CPT code 28264 should be used when a patient presents with a resistant contracture of the foot that requires surgical intervention. This code is specifically for a midtarsal capsulotomy procedure. It should not be used for other types of joint contractures or deformities.

6. Documentation requirements

To support a claim for CPT code 28264, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for the procedure
• Details of the procedure performed, including the specific joints involved
• Date of the procedure
• Any complications or unexpected findings
• Post-operative care instructions
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 28264, ensure that the procedure meets the criteria for this specific code. It is important to accurately document the details of the procedure and any associated diagnoses. CPT code 28264 should not be reported with other codes unless there are separate and distinct procedures performed. It is important to review the documentation guidelines and any applicable payer policies to ensure accurate and appropriate billing.

8. Historical information

CPT code 28264 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 patient with a resistant contracture of the midtarsal joint undergoes a capsulotomy procedure to increase range of motion in the foot.
2. A provider performs a midtarsal capsulotomy on a patient with limited mobility due to joint contracture in the foot.
3. A surgical team performs a Heyman type procedure on a patient with a severe midtarsal joint contracture.
4. A patient with a history of foot deformity undergoes a midtarsal capsulotomy to improve their ability to walk and perform daily activities.
5. A provider performs a capsulotomy on a patient with a midtarsal joint contracture caused by a previous injury.
6. A patient with a resistant contracture in the midtarsal joint undergoes a surgical procedure to release the joint and improve range of motion.
7. A provider performs a midtarsal capsulotomy on a patient with chronic foot pain and limited mobility.
8. A patient with a congenital foot deformity undergoes a capsulotomy procedure to correct joint contracture and improve function.
9. A surgical team performs a Heyman type procedure on a patient with a midtarsal joint contracture that is causing significant impairment.
10. A patient with a history of foot trauma undergoes a midtarsal capsulotomy to address joint contracture and improve their ability to walk without pain.