02/25/2002    Harry Goldsmith, DPM

Tarsal Tunnel Release & Neurectomy (William Wood, DPM)

RE: Tarsal Tunnel Release & Neurectomy (William
Wood, DPM)
From: Harry Goldsmith, DPM

"When properly performed, nerve release surgery
of the tarsal tunnel encompasses procedures and
coding for four procedures: tarsal tunnel
release; plus external neurolysis of the medial
plantar, lateral plantar; and medial calcaneal
nerves. Internal neurolysis , under
magnification, of
any of the above nerves, would be an additional
procedure." - William Wood, DPM

CPT 28035 does not merely constitute the
incisional release of the flexor retinaculum, but
globally, within the extent of the tarsal tunnel,
it includes decompression of the posterior tibial
nerve, neuroplasty, external neurolysis,
exploration and ligation of varicosities,
tenolysis, etc.

The code's design was to describe, for
reimbursement purposes, the surgical resolution
of all relevant, contributing
conditions/pathologies commonly resulting
in "tarsal tunnel syndrome".

As a "comprehensive code", it includes several
component procedures. Typically, when surgically
treating tarsal tunnel syndrome, surgeons

1) do not follow and decompress the medial and
lateral plantar nerves BEYOND the tarsal tunnel
(i.e., with an extended or separate incision
along the plantar aspect of the rear/midfoot;

2) do not use operating microscopes
(not "loops") to perform internal neurolyses of
any of these nerves for tarsal tunnel syndrome.

Obviously, if the circumstances warranted
going "beyond what is typical", the surgeon could
code/bill for any truly independent procedure, or
attach a "-22" modifier to CPT 28035, submit the
claim with a letter of explanation evidencing the
unusual nature of the case, and hope for
additional reimbursement.

But then going "beyond what is typical" would be
the exception, not the rule when it comes to
coding.

Harry Goldsmith, DPM
Cerritos, CA
hgoldsmith@codingline.com

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