Summary & Overview
CPT 27557: Open Reduction, Internal Fixation of Dislocated Knee with Ligament Repair
CPT code 27557 represents an open surgical procedure for reduction and internal fixation of a dislocated knee with primary ligament repair. This code captures complex orthopedic reconstruction aimed at restoring joint alignment and stabilizing ligamentous structures after traumatic knee dislocation. Nationally, accurate coding for such procedures matters for clinical documentation, billing integrity, and tracking utilization of high-acuity orthopedic services.
Key payers commonly involved in coverage for this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coding context, common payer coverage considerations, and clinical service characteristics relevant to billing and authorization workflows. The publication also outlines typical sites of service and reasons this code is used in operative reporting.
The analysis provides practical benchmarks for where this service is delivered, summaries of policy and authorization patterns that affect reimbursement and prior-approval needs, and clinical context for documentation elements that support medical necessity. Data not available in the input is flagged and omitted; the focus remains on describing the procedure, service setting, and payer scope to inform billing and administrative teams nationwide.
Billing Code Overview
CPT code 27557 describes an open reduction and internal fixation of a dislocated knee with repair of the primary ligament. The procedure involves surgical realignment of the knee joint (open reduction), stabilization with internal fixation devices, and concurrent repair of the main ligament responsible for knee stability.
Service type: Surgical — Orthopedic knee reconstruction and stabilization
Typical site of service: Inpatient hospital or outpatient hospital surgical suite / ambulatory surgery center depending on clinical severity and facility capabilities
Clinical & Coding Specifications
Clinical Context
A 28-year-old male presents to the emergency department after a motorcycle crash with a visibly deformed, unstable knee and severe pain. Imaging (X-ray and CT) demonstrates a traumatic knee dislocation with associated avulsion of the primary ligament (e.g., anterior cruciate ligament) and displaced tibial plateau fragments. After initial resuscitation and neurovascular assessment, the orthopedic team performs an open reduction and internal fixation to realign the joint and stabilize bony fragments, and concurrently repairs the torn primary ligament. The typical workflow includes preoperative evaluation and informed consent, anesthesia clearance, operative open reduction of the dislocation, fixation using plates/screws or intramedullary devices as indicated, primary ligament repair or reconstruction, postoperative neurovascular checks, pain control, immobilization or bracing, and discharge planning with outpatient physical therapy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard reporting | Use as default when no modifier applies for payer-specific requirements. |
11 | Normal or usual service | Appended when the procedure is performed under routine circumstances without unusual procedural service. |