Summary & Overview
CPT 27558: ORIF of Dislocated Knee with Ligament Repair
CPT code 27558 denotes an orthopedic surgical procedure: open reduction and internal fixation (ORIF) of a dislocated knee with primary ligament repair and enhancement or reconstruction. This code captures complex knee trauma care involving realignment, fixation, and soft-tissue repair, and is relevant to hospitals and ambulatory surgical centers managing acute knee dislocations and related ligamentous injury. Nationally, accurate use of this code affects clinical documentation, case mix reporting, and payment for high-acuity orthopedic services.
Key payers in typical coverage analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical services represented by the code, typical sites of service, and the payer landscape considered in benchmarking. The publication outlines coding context and operational considerations, including common modifiers and payer interactions where available. It also summarizes expected clinical scenarios tied to the code and highlights areas where documentation should support the combined fixation and ligament repair elements. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 27558 describes an open reduction and internal fixation (ORIF) procedure for a dislocated knee, performed with primary ligament repair and enhancement or reconstruction. The procedure involves surgical realignment of knee structures and fixation using internal devices, combined with repair or reconstruction of disrupted ligamentous tissue.
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Service type: Orthopedic surgical procedure — open reduction and internal fixation with ligament repair/reconstruction
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Typical site of service: Hospital inpatient or outpatient surgical center, depending on clinical severity and patient condition
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 34-year-old male presents to the emergency department after a motorcycle collision with an acute traumatic knee dislocation. He reports immediate severe pain, deformity of the knee, and inability to bear weight. Vascular status is assessed on arrival; ankle-brachial index and Doppler evaluation are performed due to concern for popliteal artery injury. After stabilization, radiographs and CT confirm tibiofemoral dislocation with associated ligamentous disruption. The patient is taken to the operating room for open reduction and internal fixation of bony injury as needed, primary repair of torn cruciate or collateral ligaments, and ligament enhancement/reconstruction as indicated. Intraoperative steps include open reduction of the dislocation, fixation of any associated fracture fragments, primary repair of the injured ligament(s) and augmentation or reconstruction using graft tissue or fixation devices. Postoperative plan includes neurovascular monitoring, immobilization in a knee brace or external fixation as indicated, early anticoagulation per institutional protocol, and staged physical therapy with weight-bearing restrictions based on fixation and vascular status. Typical site of service is the hospital operating room; this is an operative, inpatient or same-day admission procedure performed by orthopedic trauma or sports medicine surgeons specializing in lower-extremity reconstruction.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work or operative complexity substantially exceeds typical for the code (documented rationale). |