Summary & Overview
CPT 28635: Closed Reduction of Metatarsophalangeal Joint Dislocation
CPT code 28635 denotes the closed treatment (reduction) of a metatarsophalangeal joint dislocation performed under anesthesia. This code captures a common orthopedic procedure addressing traumatic or acute joint dislocations of the forefoot that require realignment without open surgery. Nationally, correct coding for this procedure matters for accurate tracking of surgical volumes, resource use (anesthesia and procedural facility time), and appropriate payment for procedural care.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service (operating room, ambulatory surgery center, or hospital outpatient department), and guidance on what to expect in coverage and billing workflows. The publication summarizes coding intent and clinical scope, presents typical utilization scenarios, and flags areas where payers commonly require documentation of anesthesia and reduction technique.
This summary is designed for national audiences including coding professionals, practice managers, and policy analysts who need a clear, practical overview of CPT code 28635, its clinical application, and its implications for billing and payer interactions. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 28635 describes the closed treatment of a metatarsophalangeal joint dislocation. The procedure involves realigning a dislocated metatarsophalangeal joint (the joint where a metatarsal bone of the foot connects to a toe phalanx) without an open surgical approach, performed under anesthesia.
Service Type: Closed orthopedic reduction of a foot joint under anesthesia
Typical Site of Service: Operating room or procedure suite (hospital outpatient department, ambulatory surgery center, or other facility where anesthesia and procedural monitoring are available)
Clinical & Coding Specifications
Clinical Context
A 28-year-old recreational soccer player presents to the emergency department after an acute inversion injury to the forefoot during play. He reports intense pain, visible deformity, and inability to move the great toe. Physical exam demonstrates dorsal dislocation of the first metatarsophalangeal joint with localized swelling and tenderness. Plain radiographs confirm a closed dislocation without fracture. The patient is consented for closed reduction under anesthesia due to pain and muscle spasm.
The clinical workflow includes triage and pain control, pre-procedure consent and time-out, administration of regional or general anesthesia, closed manual reduction of the metatarsophalangeal joint, post-reduction radiographs to confirm alignment, and immobilization with a postoperative shoe or splint. The patient is discharged with weight-bearing instructions as tolerated, analgesics, and outpatient orthopedic or podiatry follow-up for reassessment and rehabilitation planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
23 | Unusual Anesthesia | Use when a procedure is normally performed without general anesthesia but general anesthesia is required due to unusual circumstances. |
22 |