Summary & Overview
CPT 27846: Open Reduction of Ankle Dislocation with Fixation
CPT code 27846 denotes an open reduction procedure for an ankle joint dislocation, often performed when closed reduction is unsuccessful or when associated fractures or soft-tissue injury require surgical access. This code matters nationally because it captures a common acute orthopedic intervention that affects hospital surgical volumes, trauma care pathways, and payer reimbursement for operative foot and ankle services. Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical and billing overview of the procedure, typical sites of service, and the payer mix relevant to national benchmarking. The publication outlines common billing and coding considerations associated with operative management of ankle dislocations, highlights where variability in payment and utilization typically occurs across major payers, and summarizes policy or coverage topics that commonly affect claim adjudication for this procedure. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 27846 describes a surgical procedure to treat an ankle joint dislocation. The provider performs an open reduction of the ankle joint, surgically opening the dislocation site to realign the joint. The procedure may include the placement of percutaneous hardware (hardwire inserted through the skin) to hold the joint in proper alignment.
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Service type: Open surgical reduction of ankle dislocation
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Typical site of service: Operating room or other surgical suite in an acute care setting, such as a hospital or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 34-year-old male construction worker presents to the emergency department after a fall from a ladder with severe pain, deformity, and inability to bear weight on the left ankle. Initial evaluation includes trauma assessment, neurovascular exam, and ankle radiographs demonstrating an open or complex ankle dislocation with associated soft-tissue compromise. Because closed reduction attempts in the ED are unsuccessful or the dislocation is unstable or open, the orthopedic surgeon schedules an urgent operative debridement and open reduction of the ankle joint with possible percutaneous or transcutaneous fixation (e.g., Kirschner wires) to hold reduction.
Preoperative workflow includes informed consent, review of imaging, anesthesia evaluation (general or regional), and prophylactic antibiotics for open injury. Intraoperative activities include open surgical approach to the ankle joint, removal of interposed tissue, anatomic realignment, assessment of joint stability, and temporary or definitive fixation with wires or pins inserted through the skin if indicated. Postoperative workflow includes neurovascular checks, immobilization in a splint or cast, pain control, instructions regarding weight bearing, and scheduling follow-up for wound checks and hardware removal if temporary percutaneous fixation was used.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the procedure required substantially greater work than typical due to complexity, e.g., extensive debridement of contaminated open dislocation. |