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The procedure described by CPT® Code 28264 refers to a capsulotomy of the midtarsal region, specifically identified as a Heyman type procedure. In this surgical intervention, the physician performs incisions in the joint capsules located behind one or more of the bones in the foot that articulate with the ankle. This area is crucial for foot mobility and stability, as it involves the complex interplay of bones, ligaments, and tendons. The capsulotomy allows for direct access to the joint space, which can be necessary for various therapeutic reasons, such as addressing joint stiffness, relieving pain, or facilitating other surgical procedures. Understanding the anatomical and functional significance of the midtarsal joints is essential for healthcare professionals involved in the coding and billing processes, as it underscores the importance of accurate documentation and coding for optimal patient care and reimbursement.
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The capsulotomy procedure indicated by CPT® Code 28264 is typically performed for specific conditions affecting the midtarsal joints. These indications may include:
The capsulotomy procedure involves several key steps to ensure effective access to the midtarsal joints. These steps include:
After the capsulotomy procedure, patients typically require specific post-operative care to promote healing and recovery. This may include recommendations for rest, elevation of the foot, and the use of ice to reduce swelling. Patients may also be advised to avoid weight-bearing activities for a certain period, depending on the extent of the surgery and individual healing rates. Follow-up appointments are essential to monitor the healing process and assess the need for physical therapy or rehabilitation to restore mobility and strength in the affected foot. Proper adherence to post-procedure instructions is crucial for achieving optimal outcomes and minimizing complications.
| Short Descr | RELEASE OF MIDFOOT JOINT | Medium Descr | CAPSULOTOMY MIDTARSAL | Long Descr | Capsulotomy, midtarsal (eg, Heyman type procedure) | 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) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | 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 | 1 | CCS Clinical Classification | 150 - Division of joint capsule, ligament or cartilage |
| 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. | 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 | LT | Left side (used to identify procedures performed on the left side of the body) | T1 | Left foot, second digit | T2 | Left foot, third digit | T5 | Right 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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| Pre-1990 | Added | Code added. |
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