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The flexor tendons of the foot are crucial for the movement and function of the toes and foot. These tendons include several important muscles such as the peroneus longus, peroneus brevis, plantaris, popliteus, flexor digitorum longus, flexor hallucis longus, and tibialis posterior. Injuries to these tendons can occur due to various reasons, including lacerations from sharp objects or puncture wounds, which may lead to either partial or complete transection of one or more flexor tendons. Additionally, closed injuries, such as avulsions, can also result in damage to these tendons. The procedure described by CPT® Code 28200 involves making an incision over the site of the tendon or muscle injury to access the affected area. In cases where the tendon has been completely severed, the surgeon locates the ends of the tendon, pulls them together, and repairs them with sutures. If the injury is a partial transection, the surgeon will repair the transected fibers instead. In instances where the muscle itself has sustained a laceration or tear, the muscle tissue is meticulously repaired in layers to ensure proper healing. This code is specifically used to report the primary or secondary suture repair of a single flexor tendon or muscle without the use of a free graft. For cases requiring a tendon graft, CPT® Code 28202 is utilized, which involves harvesting a tendon graft and attaching it to the remnants of the severed tendon, followed by securing it at the distal insertion site. Post-repair, the range of motion is assessed, and adjustments are made to ensure optimal movement in the foot and toes, after which the surgical wound is closed in layers and the lower leg, ankle, and foot are immobilized with a splint or cast to facilitate recovery.
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The procedure described by CPT® Code 28200 is indicated for the following conditions:
The procedure begins with the surgeon making an incision over the site of the flexor tendon or muscle injury to gain access to the affected area. If the tendon has been completely transected, the surgeon locates the severed ends of the flexor tendon. The ends are grasped and pulled either distally or proximally to align them properly for repair. Once aligned, the surgeon performs a suture repair to reattach the tendon ends securely. In cases where the tendon has only been partially transected, the surgeon focuses on repairing the transected fibers to restore function. If the muscle itself has been lacerated or torn, the surgeon repairs the muscle tissue in layers to ensure proper healing and function. After the repair is completed, the surgical wound is closed in layers to promote optimal healing. Following the closure, the lower leg, ankle, and foot are immobilized using a splint or cast to prevent movement and allow for recovery. This immobilization is crucial for the healing process, ensuring that the repaired tendons and muscles can recover without undue stress.
Post-procedure care involves monitoring the surgical site for any signs of infection or complications. The patient is typically advised to keep the foot elevated and immobilized to reduce swelling and promote healing. Range of motion exercises may be introduced gradually, as directed by the healthcare provider, to restore function while ensuring that the repaired tendons and muscles are not overstressed. Follow-up appointments are essential to assess the healing process and make any necessary adjustments to the rehabilitation plan. The duration of immobilization and the timeline for resuming normal activities will depend on the extent of the injury and the individual patient's recovery progress.
| Short Descr | REPAIR OF FOOT TENDON | Medium Descr | RPR TDN FLXR FOOT 1/2 W/O FREE GRAFG EACH TENDON | Long Descr | Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5B - Ambulatory procedures - musculoskeletal | MUE | 4 | CCS Clinical Classification | 160 - Other therapeutic procedures on muscles and tendons |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | RT | Right side (used to identify procedures performed on the right side of the body) | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | LT | Left side (used to identify procedures performed on the left side of the body) | SG | Ambulatory surgical center (asc) facility service | T1 | Left foot, second digit | T2 | Left foot, third digit | T3 | Left foot, fourth digit | T4 | Left foot, fifth digit | T5 | Right foot, great toe | T6 | Right foot, second digit | T7 | Right foot, third digit | T8 | Right foot, fourth digit | T9 | Right foot, fifth digit | TA | Left foot, great toe | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| Pre-1990 | Added | Code added. |
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