CPT® Code 28238

Reconstruction (advancement), posterior tibial tendon with excision of accessory tarsal navicular bone (eg, Kidner type procedure)

The procedure described by CPT® Code 28238 involves the surgical reconstruction of the posterior tibial tendon, specifically through an advancement technique, which is performed in conjunction with the excision of an accessory tarsal navicular bone. The accessory navicular bone is an additional bone located on the medial side of the foot, proximal to the navicular bone, and is present in some individuals. This anatomical variation can lead to complications, particularly when the tibialis posterior tendon, which typically inserts on the navicular bone, becomes displaced due to the presence of the accessory bone. Such displacement can result in a valgus deformity of the foot, where the foot deviates outward. Furthermore, the accessory navicular bone may become enlarged or sustain injury, leading to pain during ambulation. Surgical intervention is indicated when conservative treatments fail to alleviate the pain associated with the accessory navicular bone. The surgical approach involves making a skin incision over the medial aspect of the foot, allowing for direct access to the tendon and the accessory bone, facilitating their excision and subsequent reconstruction of the tendon to restore proper foot mechanics.