Summary & Overview
CPT 28445: Open Treatment of Talus Fracture
CPT code 28445 represents the open surgical treatment of talus fractures, a clinically significant procedure given the talus's central role in ankle stability and weight bearing. Proper coding of this procedure affects hospital and surgical facility reporting, case-mix considerations, and national utilization monitoring for orthopedic trauma care. The code covers open reduction with or without internal fixation using implants such as pins or screws.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national perspective on clinical context and common sites of service for this procedure, plus coverage-relevant considerations and benchmarks where available. The publication summarizes clinical indications, typical surgical settings (hospital inpatient, hospital outpatient, and select ambulatory surgical centers), and coding implications for surgical treatment of talus fractures.
This summary guides coding professionals, surgical departments, and policy analysts on the core attributes of CPT code 28445, clarifying what the code denotes and what users should expect in national reporting and payer interactions. Data not available in the input is noted where specific payer coverage policies, associated taxonomies, ICD-10 pairings, and related codes would otherwise be detailed.
Billing Code Overview
CPT code 28445 describes the open treatment of a talus fracture, a surgical procedure to address fractures of the talus bone in the ankle. The procedure may include internal fixation using devices such as pins or screws, but fixation is optional depending on fracture pattern and surgeon judgment.
-
Service type: Open surgical fracture treatment/orthopedic surgery
-
Typical site of service: Hospital inpatient or hospital outpatient surgical setting; may also be performed in ambulatory surgical centers for select cases
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult who sustained an acute ankle injury from a fall or motor vehicle collision and presents with localized pain, swelling, and inability to bear weight. Initial evaluation includes history, physical exam, and imaging (plain radiographs and often CT) confirming a displaced or unstable talus fracture. The orthopedic foot and ankle surgeon counsels the patient on operative management to restore articular congruity and prevent avascular necrosis. The procedure 28445 is performed in an ambulatory surgery center or hospital operating room under general or regional anesthesia. Intraoperative workflow includes open exposure of the talus, fracture reduction, provisional fixation with K-wires as needed, definitive internal fixation with screws or plates when indicated, hemostasis, and layered closure. Postoperative workflow includes recovery room monitoring, immobilization in a splint or cast, pain control, neurovascular checks, weight-bearing instructions (typically non–weight-bearing), and early scheduled follow-up with repeat radiographs and physical therapy as appropriate.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the work, time, or technical difficulty substantially exceeds the usual for 28445 and documentation supports increased work. |