Summary & Overview
CPT 28420: Open Calcaneal Fracture Repair with Cancellous Bone Graft
CPT code 28420 represents open surgical repair of a calcaneal (heel bone) fracture with cancellous bone grafting, a complex orthopedic procedure used when fractures require direct reduction and biological augmentation. This code captures both the fixation of the calcaneus—using screws, nails, or other implants—and the separate harvest and placement of a cancellous graft, commonly from the iliac crest. Nationwide, accurate coding for this service is important for clinical communication, quality measurement, and payment for complex lower-extremity trauma care.
Key payers addressed in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise national overview of what CPT code 28420 covers, typical sites of service, and the clinical context in which it is used. The publication outlines benchmarking metrics, common billing and documentation considerations, and recent policy or coding guidance that affect claims processing and allowable services. The content is intended for coding professionals, orthopedic surgeons, and revenue cycle staff seeking a practical reference for clinical documentation and payer expectations related to open calcaneal fracture repair with bone grafting.
Data not available in the input for some supplemental elements (e.g., associated taxonomies, full payer-specific policy details).
Billing Code Overview
CPT code 28420 describes an open surgical treatment of a calcaneal (heel bone) fracture with cancellous bone graft. The procedure involves internal fixation of the calcaneus, which may include implants such as screws or nails, combined with harvesting a cancellous bone graft—typically from the iliac crest—through a separate incision and using that graft to augment fracture fixation.
Service type: Surgical — Open fracture repair with bone grafting
Typical site of service: Inpatient or outpatient surgical setting, generally performed in an operating room
Clinical & Coding Specifications
Clinical Context
A 42-year-old male presents to the emergency department after a fall from a ladder onto his right heel. Imaging (plain radiographs and CT) demonstrates a displaced intra-articular fracture of the right calcaneus with significant comminution and loss of subtalar joint height. Nonoperative management is unlikely to restore anatomy or function. The patient is scheduled for open reduction and internal fixation of the calcaneal fracture with cancellous autograft harvested from the ipsilateral iliac crest.
Preoperative workflow includes history and physical, consent for both calcaneal ORIF and iliac crest bone graft harvest, preoperative labs and anesthesia evaluation. In the operating room, the orthopedic surgeon performs an extensile lateral or sinus tarsi approach to expose the calcaneus, reduces the fracture fragments, places fixation (screws and/or plates), and packs cancellous bone graft obtained through a separate incision at the iliac crest. Postoperative workflow includes pain control, wound care instructions for both sites, immobilization in a splint or boot, and scheduled follow-up for radiographic assessment and progressive weight-bearing as tolerated per surgeon protocol.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
51 | Multiple procedures | When additional unrelated procedures are performed at the same operative session in separate anatomic regions and payor requires modifier for correct payment sequencing |