How To Use CPT Code 28737

CPT 28737 describes a surgical procedure that involves the immobilization of the navicular and cuneiform tarsal bones in the foot, along with the lengthening and advancement of the tibialis posterior tendon. 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 28737?

CPT 28737 is a code used to describe a surgical procedure that involves the fusion of the navicular and cuneiform tarsal bones in the foot, along with the lengthening and advancement of the tibialis posterior tendon. This procedure is performed to correct a flexible flat foot and improve the patient’s foot function and stability.

2. Official Description

The official description of CPT code 28737 is: ‘Arthrodesis, with tendon lengthening and advancement, midtarsal, tarsal navicular-cuneiform (eg, Miller type procedure).’ This procedure involves the surgical immobilization of the navicular and cuneiform tarsal bones in the foot, along with the lengthening and advancement of the tibialis posterior tendon.

3. Procedure

1. The surgeon begins by making an incision in the skin over the mid portion of the third metatarsal, extending it over to the mid portion of the navicular bone.
2. Through this incision, the surgeon dissects down through the subcutaneous tissue, preserving the nerves and veins.
3. An osteoperiosteal flap is created, including the tibialis posterior tendon.
4. The surgeon then retracts the muscle to gain access to the joints that need to be fused.
5. The joint capsule is cut, and the surgeon enters the joint to remove any dead or inflamed tissue.
6. The bones of the joints are brought into close proximity and fused using implants such as K wires, screws, or plates.
7. The tibialis tendon is moved forward and sutured to the first cuneiform bone and the base of the first metatarsal bone.
8. Hemostasis is achieved at the surgical site, and the wound is closed by suturing the soft tissue in layers.
9. A cast or brace is then placed on the ankle to immobilize the foot for a period of four to six weeks.

4. Qualifying circumstances

CPT 28737 is typically performed on patients with a flexible flat foot condition that requires correction. The procedure is indicated when conservative treatments have failed to provide adequate relief and the patient experiences significant pain or functional limitations. The patient must be evaluated by a qualified surgeon who determines the need for the procedure based on the patient’s symptoms, physical examination, and imaging studies.

5. When to use CPT code 28737

CPT code 28737 should be used when a surgeon performs the arthrodesis, tendon lengthening, and advancement procedure on the midtarsal, tarsal navicular-cuneiform joints. This code is appropriate when the surgeon fuses the navicular and cuneiform bones and performs the necessary tendon lengthening and advancement to correct a flexible flat foot condition.

6. Documentation requirements

To support a claim for CPT code 28737, the surgeon must document the following information:

• Patient’s diagnosis and the need for the surgical procedure
• Details of the procedure performed, including the specific bones fused and the technique used for tendon lengthening and advancement
• Date of the surgery
• Any additional procedures performed during the same surgical session
• Any complications or unexpected findings encountered during the procedure
• Postoperative care instructions and follow-up plans
• Signature of the surgeon performing the procedure

7. Billing guidelines

When billing for CPT code 28737, ensure that the procedure performed matches the description provided in the code. It is important to accurately document the specific bones fused and the technique used for tendon lengthening and advancement. CPT code 28737 should not be reported with other codes that describe different procedures or anatomical locations. It is essential to follow the guidelines provided by the payer and use appropriate modifiers if necessary.

8. Historical information

CPT code 28737 was added to the Current Procedural Terminology system on January 1, 1990. The code underwent a change on January 1, 2002, with a modification to the description of the procedure.

9. Examples

1. A patient with a flexible flat foot undergoes arthrodesis, tendon lengthening, and advancement of the midtarsal, tarsal navicular-cuneiform joints to correct their foot deformity.
2. A surgeon performs the fusion of the navicular and cuneiform bones, along with the lengthening and advancement of the tibialis posterior tendon, in a patient with significant pain and functional limitations due to a flexible flat foot condition.
3. Arthrodesis, tendon lengthening, and advancement of the midtarsal, tarsal navicular-cuneiform joints are performed on a patient with a congenital foot deformity.
4. A surgeon corrects a flexible flat foot in a patient by fusing the navicular and cuneiform bones and performing the necessary tendon lengthening and advancement.
5. A patient with a flexible flat foot undergoes surgical intervention, including the fusion of the midtarsal, tarsal navicular-cuneiform joints and the lengthening and advancement of the tibialis posterior tendon.
6. Arthrodesis, tendon lengthening, and advancement of the midtarsal, tarsal navicular-cuneiform joints are performed on a patient with chronic foot pain and instability.
7. A surgeon corrects a flexible flat foot deformity in a patient by surgically immobilizing the navicular and cuneiform tarsal bones and performing the necessary tendon lengthening and advancement.