Summary & Overview
CPT 28600: Closed Treatment of Tarsometatarsal Joint Dislocation
CPT code 28600 represents the closed treatment of a tarsometatarsal joint dislocation, a non‑operative reduction of an abnormal separation between the tarsal and metatarsal bones in the midfoot or rearfoot. This code captures a focused, often urgent procedure that can be performed without open surgery and may occur in emergency, urgent care, or outpatient settings. Nationally, accurate coding for this procedure affects clinical documentation, acute care workflows, and appropriate payer adjudication for foot trauma management.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes coverage patterns, common billing modifiers observed in practice, and service line considerations across commercial and public payers. Readers will find clinical context for when closed reduction is indicated, typical sites of service, and operational benchmarks relevant to emergency and ambulatory settings. The report also outlines commonly used modifiers and areas where documentation influences reimbursement and claim acceptance. Data not available in the input is noted where applicable. This resource is intended for coding professionals, clinicians involved in acute foot trauma care, and payer policy analysts seeking a concise reference on CPT code 28600.
Billing Code Overview
CPT code 28600 describes the closed treatment of a tarsometatarsal joint dislocation. The procedure involves manipulation to reduce an abnormal separation between a tarsal bone and a metatarsal bone in the midfoot or rearfoot without open surgical exposure.
Service Type: Closed joint reduction of the tarsometatarsal joint (non‑operative)
Typical Site of Service: Emergency department, urgent care, or outpatient clinic setting; may also occur in a hospital procedure or operating room when required for patient comfort or concomitant injuries.
Clinical & Coding Specifications
Clinical Context
A 34-year-old male presents to the emergency department after a fall from a ladder with acute midfoot pain, swelling, and inability to bear weight on the affected foot. Physical exam demonstrates midfoot deformity and point tenderness over the tarsometatarsal (Lisfranc) region. Plain radiographs confirm a tarsometatarsal joint dislocation without open wound. The orthopedic surgeon performs a 28600 closed reduction of the tarsometatarsal joint in the ED without general anesthesia, using local infiltration and conscious patient cooperation, followed by immobilization in a short leg cast or boot. Post-reduction radiographs confirm alignment. The clinical workflow includes initial triage and analgesia, imaging (plain radiographs ± weight-bearing views), informed consent, closed reduction performed at bedside or in an ED procedure area, post-procedure neurovascular checks, immobilization, and discharge with non-weight-bearing instructions and orthopedic follow-up within 7–14 days for reassessment and possible fixation if instability recurs.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
23 | Unusual Anesthesia | Use if the procedure is performed when general anesthesia is medically contraindicated and additional anesthesia care is required without standard anesthesia services. |