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Official Description

Repair, tendon, extensor, foot; primary or secondary, each tendon

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 28208 involves the surgical repair of extensor tendons in the foot, which are crucial for the movement and function of the toes and foot. The extensor tendons include several key muscles such as the tibialis anterior, extensor digitorum, peroneus tertius, and extensor hallucis longus. These tendons can be injured through various mechanisms, including lacerations, puncture wounds, or closed injuries like avulsions, which can lead to either partial or complete transection of the tendon. In cases of complete transection, the surgical approach involves making an incision over the injury site to locate the severed ends of the tendon. The surgeon then repairs the tendon by suturing the ends together. If the injury is a partial transection, the procedure focuses on repairing the damaged fibers of the tendon. Additionally, if the muscle itself is lacerated, the repair involves suturing the muscle tissue in layers to restore its integrity. This procedure is essential for restoring function and mobility to the foot and toes, and it is reported using the CPT® Code 28208 for primary or secondary suture repair of a single extensor tendon or muscle.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure is indicated for various conditions that result in injury to the extensor tendons of the foot. These include:

  • Lacerations - Cuts that may completely or partially sever the extensor tendons.
  • Puncture Wounds - Injuries that penetrate the skin and can damage the tendons beneath.
  • Avulsion Injuries - Closed injuries where the tendon is pulled away from its attachment point, leading to partial or complete transection.

2. Procedure

The surgical procedure for repairing extensor tendons involves several critical steps, which are detailed as follows:

  • Step 1: Incision - The surgeon begins by making an incision over the site of the extensor tendon or muscle injury. This incision allows access to the damaged tendon for repair.
  • Step 2: Identification of the Tendon - If the tendon has been completely transected, the surgeon locates the severed ends of the tendon. This may involve careful dissection to ensure that the tendon is adequately exposed for repair.
  • Step 3: Tendon Repair - Once the severed ends are identified, the surgeon grasps the tendon and pulls it distally or proximally to align the ends. The ends of the tendon are then sutured together to restore continuity. In cases of partial transection, the surgeon repairs the transected fibers directly.
  • Step 4: Muscle Repair (if applicable) - If the muscle itself has been lacerated, the surgeon repairs the muscle tissue in layers to ensure proper healing and function.
  • Step 5: Graft Repair (if applicable) - For cases requiring a tendon graft, a graft is harvested and attached to the remnants of the severed tendon in the lower leg. The graft is then secured at the distal insertion site of the tendon.
  • Step 6: Range of Motion Testing - After the repair, the surgeon tests the range of motion of the foot and toes, adjusting the tension as necessary to ensure optimal movement.
  • Step 7: Wound Closure - The surgical wound is closed in layers to promote healing and minimize scarring.
  • Step 8: Immobilization - Finally, the lower leg, ankle, and foot are immobilized using a splint or cast to protect the repair during the initial healing phase.

3. Post-Procedure

Post-procedure care involves monitoring the surgical site for signs of infection and ensuring proper healing of the tendon and muscle repairs. Patients are typically advised to keep the foot elevated and immobilized to reduce swelling and promote recovery. Physical therapy may be recommended to restore strength and range of motion as healing progresses. Follow-up appointments are essential to assess the healing process and make any necessary adjustments to the rehabilitation plan.

Short Descr REPAIR OF FOOT TENDON
Medium Descr REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON
Long Descr Repair, tendon, extensor, foot; primary or secondary, 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
LT Left side (used to identify procedures performed on the left side of the body)
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
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).
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).
81 Minimum assistant surgeon: minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number.
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
F5 Right hand, thumb
FA Left hand, thumb
GA Waiver of liability statement issued as required by payer policy, individual case
GC This service has been performed in part by a resident under the direction of a teaching physician
RT Right side (used to identify procedures performed on the right 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
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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