Summary & Overview
CPT 27556: Open Reduction and Internal Fixation of Dislocated Knee
CPT code 27556 represents an open reduction and internal fixation procedure to correct a dislocated knee without primary ligament repair or reconstruction. This orthopedic surgical code captures interventions to realign and stabilize the knee joint using internal fixation hardware following dislocation. Nationally, the code matters for surgical case classification, facility and professional billing, and for tracking utilization of knee stabilization procedures outside primary ligament reconstruction.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical procedure associated with the code, typical sites where the service is delivered, and the payer landscape relevant to reimbursement and coverage review. The publication highlights benchmarks and policy considerations that affect billing and claims adjudication, including common modifiers used with surgical services and practice patterns relevant to orthopedic surgery.
The content provides clinical context for coders and policy analysts, outlines where this service typically occurs, and identifies areas for further review such as documentation that distinguishes fixation-only procedures from those including ligament repair. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 27556 describes an open reduction and internal fixation of a dislocated knee where the provider corrects the dislocation and performs internal fixation but does not perform a primary ligament repair or reconstruction. The service type is an orthopedic surgical procedure focused on reduction and stabilization of the knee joint. The typical site of service is an inpatient or ambulatory surgical setting such as a hospital operating room or an outpatient surgical center.
Clinical & Coding Specifications
Clinical Context
A 34-year-old male presents after a high-energy motor vehicle collision with a grossly unstable, dislocated knee. Initial evaluation in the emergency department includes neurovascular assessment, radiographs, and reduction attempts. Closed reduction in the ED is unsuccessful or incomplete, and persistent instability with associated fractures about the knee necessitates operative management. The operative plan is open reduction and internal fixation to anatomically realign bony structures and restore joint stability without performing primary ligament repair or reconstruction. Typical workflow: preoperative imaging (AP/lateral knee and CT if complex fracture), consent, anesthesia evaluation (general or regional), operative open reduction and internal fixation of tibial plateau, distal femur, or patellar fractures with stabilization using plates, screws, or intramedullary devices as indicated, intraoperative fluoroscopy, wound closure, and postoperative neurovascular checks. Postoperative care includes immobilization or hinged knee brace, DVT prophylaxis, pain control, physical therapy initiation per fixation stability, and outpatient follow-up for wound checks and radiographic union assessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the work, time, or intensity substantially exceeds usual for 27556 and documentation supports additional work. |