Summary & Overview
CPT 28116: Excision of Tarsal Coalition
CPT code 28116 identifies the surgical excision of a tarsal coalition, a procedure performed to separate abnormally fused tarsal bones and restore foot joint mobility. This code is used in claims for definitive surgical management of symptomatic tarsal coalitions and has relevance for orthopedic and podiatric surgical practices across the United States. Nationally, accurate coding for this procedure affects procedural tracking, payment adjudication, and quality measurement for foot and ankle surgery.
Key payers commonly involved in coverage and payment for this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Payer policies may differ on medical necessity criteria, preauthorization requirements, and site-of-service preferences for outpatient surgical centers versus hospital settings.
Readers will find clinical context on when the procedure is used, coding clarity for claim submission, and a summary of the payer landscape. The publication also outlines benchmarks and policy-relevant considerations affecting authorization and reimbursement, as well as ancillary topics such as associated service settings and common billing modifiers. Data not available in the input is noted where payer-specific policies, ICD-10 pairings, and related codes would normally be detailed.
Billing Code Overview
CPT code 28116 describes the surgical removal of a tarsal coalition, a bridge of bone or fibrous tissue that abnormally fuses tarsal bones in the foot and restricts joint motion. The procedure involves excision of the coalition to restore motion between the affected tarsal bones and relieve pain or mechanical symptoms.
Service Type: Surgical — foot/orthopedic procedure
Typical Site of Service: Hospital outpatient surgical suite or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A typical patient is an adolescent or young adult who presents with persistent lateral foot pain, recurrent ankle sprains, and limited subtalar motion unresponsive to conservative care. The patient often reports pain with activity, reduced push-off strength, and aching at the sinus tarsi or along the lateral hindfoot. Prior evaluation includes weight-bearing radiographs and CT or MRI confirming a tarsal coalition (such as calcaneonavicular or talocalcaneal coalition) causing osseous or fibrous bridging between tarsal bones.
The clinical workflow begins with outpatient evaluation by an orthopedic foot and ankle surgeon. Nonoperative measures—activity modification, orthotics, immobilization, NSAIDs, and physical therapy—are attempted for months. If symptoms persist and imaging correlates with limited hindfoot motion or degenerative changes, the surgeon schedules operative management. In the operating room under general or regional anesthesia, the surgeon performs 28116 (resection of tarsal coalition) through a lateral or medial approach, often with interposition grafting (fat or local tissue) to prevent recurrence. Postoperative care includes immobilization in a cast or boot, progressive weight-bearing as tolerated, and outpatient physical therapy. Typical sites of service are inpatient hospital operating room or ambulatory surgery center depending on patient comorbidity and complexity. Common payors for authorization and claims include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
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