Query: Baxter Nerve Compression
When performing an anterior or distal tarsal
tunnel release to correct a Baxter nerve (the
first branch of the lateral plantar nerve; a
motor sensory branch which supplies sensory
nerves to the periosteum of the calcaneus and
motor nerves to the abductor digiti quinti
muscle; noted in the distal portion of the
tarsal tunnel) compression, which is the more
appropriate code to use:
CPT 28035 (release, tarsal tunnel [posterior
tibial nerve decompression]) or
CPT 64704 (neuroplasty,nerve of hand or foot)?
If a calcaneal spur is removed through the same
incision, should CPT 28119 (calcaneal ostectomy,
with or without plantar fascia release) also be
billed?
John Moglia, DPM
Berkeley Hts, NJ
Codingline Response: This is not an issue of
whether or not these procedures were performed
through the same incision. If there were
unrelated pathologies necessitating the
surgeon's attention (i.e., heel spur resection
and neuritis of Baxter's nerve, then I feel it
would reasonable to bill each procedure
separately. The operative note should describe
each procedure (including the operative
findings).
I recommend billing CPT 28119 for the heel spur
excision with/without fasciotomy, and CPT 64722
for the decompression of nerve itself. CPT
28035 is specific for posterior tibial nerve
decompression at the tarsal canal (release of
the tarsal tunnel), and this was not done
according to the information you provided.
Howard Zlotoff, DPM
Camp Hill, PA
