Summary & Overview
CPT 28436: Closed Talus Fracture Manipulation with Percutaneous Fixation
CPT code 28436 denotes closed treatment of a talus fracture with manipulation and percutaneous fixation using screws and/or pins. This surgical procedure matters nationally because talar fractures affect mobility and often require timely, skilled operative management to reduce complications such as post-traumatic arthritis and avascular necrosis. Accurate coding of 28436 is essential for clinical documentation, resource planning, and claims adjudication across inpatient and ambulatory surgical settings.
Key payers addressed in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for percutaneous fixation of talus fractures, typical sites of service, and the implications of using CPT code 28436 for billing workflows. The publication also summarizes payer coverage patterns and benchmarks where available, highlights relevant coding considerations affecting reimbursement and utilization, and outlines policy updates and documentation elements that influence claims review. This content is designed for clinicians, coding professionals, and revenue cycle stakeholders seeking a national perspective on coding and clinical context for CPT code 28436.
Billing Code Overview
CPT code 28436 describes closed treatment of a talus fracture using percutaneous fixation with screws and/or pins combined with manipulation of the fractured bone. The procedure involves realignment (manipulation) of the talar fracture and placement of internal fixation devices through the skin rather than open exposure.
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Service type: Surgical fracture management, percutaneous internal fixation with manipulation
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Typical site of service: Hospital operating room or ambulatory surgical center, depending on clinical complexity and patient status
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Clinical & Coding Specifications
Clinical Context
A 34-year-old male presents to the emergency department after an ankle inversion injury from a fall from a ladder. Imaging (plain radiographs and CT) demonstrates a displaced talus fracture with articular step-off and instability. The orthopedic trauma surgeon schedules an open or percutaneous fixation procedure using screws and/or pins to reduce and stabilize the talar fracture. The workflow includes preoperative evaluation, informed consent, anesthesia (general or regional), intraoperative manipulation (closed or limited open reduction) of the talus to achieve alignment, percutaneous placement of screws and/or pins under fluoroscopic guidance, wound dressing and immobilization, and postoperative radiographs. Typical postoperative care includes short-term non–weight-bearing in a splint or cast, pain control, thromboprophylaxis as indicated, and outpatient follow-up for radiographic healing and potential hardware removal.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
62 | Two surgeons | Use when two surgeons work together as primary surgeons on complex talar reconstruction where each performs distinct portions of the procedure. |
66 | Surgical team | Use when a surgical team (multiple qualified surgeons functioning as a team) performs the operation due to complexity or patient condition. |