Summary & Overview
CPT 28238: Posterior Tibial Tendon Reposition and Accessory Navicular Excision
CPT code 28238 represents a surgical foot procedure that repositions the posterior tibial tendon and removes an accessory tarsal navicular bone to relieve medial foot pain and tendon dysfunction. Nationally, this code is relevant for orthopedics and podiatry practices treating symptomatic accessory navicular and associated posterior tibial tendon pathology. It captures an operative intervention that can prevent progressive tendon dysfunction and improve patient mobility.
Key payers addressed in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find a concise clinical context for the procedure, common sites of service, and the typical service type. The publication also provides billing and policy context relevant to national payers, including common modifiers used with this procedure when available.
This summary prepares clinical administrators, coding staff, and policy analysts to interpret the code in operational and administrative workflows. Content includes clinical indications and coding scope, payer coverage topics, and where to look for policy updates affecting surgical foot procedures. Information not provided in the input (such as associated ICD-10 codes, taxonomies, or payer-specific coverage rules) is noted as unavailable.
Billing Code Overview
CPT code 28238 describes a surgical procedure in which the provider repositions the posterior tibial tendon and excises an accessory tarsal navicular bone (an extra bone on the inner side of the foot) to relieve pain and discomfort. This procedure addresses symptomatic accessory navicular and dysfunction related to the posterior tibial tendon.
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Service type: Surgical repair/reconstruction of the posterior tibial tendon with excision of accessory navicular
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Typical site of service: Ambulatory surgery center or inpatient hospital operating room
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Clinical & Coding Specifications
Clinical Context
A typical patient is a 30–55 year-old ambulatory adult presenting with medial-sided ankle and foot pain, weakness of ankle inversion, and a palpable prominence over the navicular. Symptoms often include activity-related pain, swelling, and difficulty with single-leg heel rise. Conservative measures (orthotics, anti-inflammatories, activity modification, physical therapy) were attempted for several months without durable relief. Imaging (standing foot radiographs and MRI or CT) demonstrates an accessory (ossicle) navicular with posterior tibial tendon irritation or partial tearing and medial column dysfunction. The surgical workflow includes preoperative evaluation and informed consent, regional or general anesthesia, intraoperative fluoroscopy as needed, a medial incision to expose the posterior tibial tendon and accessory navicular, excision of the accessory bone, tendon debridement and repositioning or repair, possible suture anchor fixation if tendon detachment is performed, layered closure, sterile dressing and short leg splint or cast, and postoperative recovery with non-weight-bearing or protected weight-bearing and physical therapy for rehabilitation. Typical site of service is an ambulatory surgery center or hospital outpatient surgical suite. Payors commonly involved include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the surgeon's professional service separate from the facility or technical component, e.g., when facility bills separately. |