Summary & Overview
CPT 28262: Reconstructive Clubfoot Repair with Tendon Lengthening
CPT code 28262 denotes an extensive reconstructive procedure for clubfoot that persists or recurs after prior surgical correction. The code captures open soft-tissue work on the ankle and foot, including incision of the talotibial (ankle) joint capsule and tendon lengthening or division to reduce contracture and improve alignment. Nationally, this code represents a specialized orthopedic surgical service commonly performed in hospital operating rooms or ambulatory surgery centers and is relevant to pediatric and reconstructive foot and ankle practices.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, common payer considerations, and an outline of content typically included in billing and policy reviews: coding intent, service and site implications, and where to look for documentation and prior-procedure history that support use of the code. The material highlights benchmarks and policy topics relevant to surgical foot reconstruction, such as coverage criteria for repeat or revision procedures and documentation requirements to substantiate medical necessity. Data not available in the input is noted where applicable, and the summary focuses on national implications for coding, billing, and clinical teams involved in reconstructive foot surgery.
Billing Code Overview
CPT code 28262 describes an extensive surgical repair for a recurrent or refractory clubfoot (congenital talipes) that has not responded to prior surgical correction. The procedure includes incision of the talotibial joint capsule and lengthening or division of one or more tendons to relieve soft-tissue tension and realign the foot.
Service type: Orthopedic surgical procedure — reconstructive/soft-tissue repair of the foot and ankle
Typical site of service: Hospital operating room or ambulatory surgery center, with perioperative care in preoperative and postoperative settings.
Clinical & Coding Specifications
Clinical Context
A school-aged child with a recurrent, rigid clubfoot (talipes equinovarus) presents to an orthopedic clinic after prior soft-tissue or bony procedures failed to produce a functional, plantigrade foot. The child has persistent forefoot adduction, hindfoot varus, and ankle stiffness with pain and limited ambulation. The orthopedic surgeon evaluates deformity severity with physical exam and weight‑bearing radiographs, documents prior surgeries and current functional limitations, and obtains anesthesia clearance.
In the operating room under regional or general anesthesia, the surgeon performs an extensive corrective soft-tissue procedure including capsulotomy of the talotibial (ankle) joint and lengthening or release of one or more tendons (for example, Achilles tendon lengthening, posterior tibial tendon release) to relieve contracture and restore alignment. Intraoperative fluoroscopy may be used to confirm correction. Postoperative care includes immobilization in a cast or boot, analgesia, wound care, and a plan for physical therapy and follow-up radiographs. Typical site of service is an outpatient ambulatory surgery center or hospital operating room. Typical service type is operative musculoskeletal (podiatric/orthopedic) surgery for congenital deformity correction.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the surgeon's professional services separate from facility/technical components (rare for operative services). |