CPT 28645: Open Treatment of Metatarsophalangeal Joint Dislocation - OpenPayer

Summary & Overview

CPT 28645: Open Treatment of Metatarsophalangeal Joint Dislocation

CPT code 28645 denotes open surgical treatment of a metatarsophalangeal (MTP) joint dislocation, a procedure used to correct abnormal separation between a metatarsal and a toe phalanx. This code captures cases where the surgeon exposes the joint and may use internal fixation, such as pins or screws, to stabilize the repair. Nationally, accurate coding for MTP open reductions matters for appropriate procedure classification, surgical quality measurement, and facility billing across inpatient and ambulatory surgery settings.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise overview of clinical context, common sites of service, and payer considerations relevant to reimbursement and authorization workflows. Readers will find benchmarks for utilization and allowed services, coding nuances that affect claim adjudication, and summaries of any notable policy or coverage updates where available.

The content is intended for clinicians, coding professionals, and revenue cycle managers seeking a clear, national-level reference for CPT code 28645, including when the code applies, typical care settings, and payer coverage landscape. Data not available in the input is identified explicitly.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare28645CPTmetatarsophalangealfoot surgeryopen reductionorthopedicspodiatrysurgical-procedure

Billing Code Overview

CPT code 28645 describes open treatment of a metatarsophalangeal joint dislocation, an operative procedure to correct abnormal separation between a metatarsal and a phalanx in the foot. The surgeon performs direct exposure of the joint to reduce the dislocation and restore normal alignment. Internal fixation devices such as pins or screws may be used at the surgeon's discretion to stabilize the joint.

Service type: Surgical — Open reduction of joint dislocation

Typical site of service: Hospital operating room or ambulatory surgery center, with procedures performed by orthopedic or podiatric surgeons specializing in foot and ankle care.

Clinical & Coding Specifications

Clinical Context

A 34-year-old patient presents to the emergency department after twisting the forefoot during a fall from a ladder. The patient has acute pain, visible deformity at the great toe metatarsophalangeal joint, and inability to bear weight. Radiographs demonstrate a dorsal dislocation of the first metatarsophalangeal joint with soft-tissue interposition preventing closed reduction. The orthopedic surgeon schedules an open reduction and possible internal fixation under regional or general anesthesia. The typical workflow includes preoperative assessment (history, neurovascular exam, imaging review), informed consent, surgical site marking, administration of anesthesia, open exposure of the affected metatarsophalangeal joint, reduction of the dislocation, and fixation if needed using temporary pins or screws. Postoperative care includes wound dressing, immobilization in a postoperative shoe or boot, pain control, instructions for non-weightbearing or protected weightbearing, and short-interval follow-up for wound check and radiographic confirmation of reduction and hardware position.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typical for open reduction of a MTP joint (extensive dissection, removal of devitalized tissue).
`23`

CPT 28570: Closed Reduction of Talotarsal Joint Dislocation Without Anesthesia

cpt-28660-toe-interphalangeal-joint-closed-reduction-no-anesthesia

CPT 28660: Closed Reduction of Toe Interphalangeal Joint Dislocation

cpt-28515-toe-phalanx-fracture-closed-manipulation

CPT 28515: Closed Treatment of Toe Phalanx Fracture, Non-Great Toe

cpt-28605-closed-treatment-tarsometatarsal-dislocation

CPT 28605: Closed Treatment of Tarsometatarsal Joint Dislocation

cpt-28576-talotarsal-joint-dislocation-percutaneous-fixation

CPT 28576: Percutaneous Fixation for Talotarsal Joint Dislocation

cpt-28475-metatarsal-fracture-closed-manipulation

CPT 28475: Closed Treatment of Metatarsal Fracture with Manipulation

cpt-28630-metatarsophalangeal-joint-closed-reduction-no-anesthesia

CPT 28630: Closed Reduction of Metatarsophalangeal Joint Dislocation

cpt-28490-great-toe-phalanx-fracture-repair-nonoperative

CPT 28490: Repair of Great Toe or Phalanx Fracture Without Surgery

cpt-28675-open-treatment-interphalangeal-joint-dislocation-toe

CPT 28675: Open Treatment of Toe Interphalangeal Joint Dislocation

cpt-28525-open-treatment-toe-phalanx-fracture

CPT 28525: Open Treatment of Toe Phalanx Fracture

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Taxonomy Code	Specialty	Notes
207P00000X	Podiatry	Podiatrists commonly perform open treatment of MTP joint dislocations.
207L00000X	Orthopedic Surgery	Orthopedic foot and ankle surgeons frequently manage complex MTP dislocations.
2080P0004X	General Surgery (Podiatric Surgeon subcategory)	General orthopedic or foot-focused general surgeons may perform this procedure in some settings.
207K00000X	Orthopedic Surgery of the Foot and Ankle (subspecialty)	Subspecialists with foot and ankle focus perform open reductions and fixation when needed.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S93.05XA`	Dislocation of metatarsophalangeal joint of right great toe, initial encounter	Represents an acute MTP joint dislocation that may require open reduction when closed reduction fails.
`S93.06XA`	Dislocation of metatarsophalangeal joint of left great toe, initial encounter	Same relevance for the left great toe.
`S93.152A`	Dislocation of interphalangeal joint of right lesser toe, initial encounter	Lesser toe MTP/IP dislocations that can require open treatment if irreducible.
`S93.153A`	Dislocation of interphalangeal joint of left lesser toe, initial encounter	Left-side counterpart for lesser toe dislocation.
`S93.211A`	Dislocation of other metatarsophalangeal joint of right foot, initial encounter	Covers dislocations of other toes' MTP joints when open treatment indicated.
`S93.212A`	Dislocation of other metatarsophalangeal joint of left foot, initial encounter	Left foot counterpart for other MTP joint dislocations.
`S92.331A`	Displaced fracture of proximal phalanx of right great toe, initial encounter for closed fracture	Included when fracture-dislocation is present and fixation may be required.
`S92.332A`	Displaced fracture of proximal phalanx of left great toe, initial encounter for closed fracture	Left-side fracture-dislocation scenario requiring open reduction and fixation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`28645`	Open treatment of metatarsophalangeal joint dislocation; with or without internal fixation	Primary procedure for open reduction of MTP joint dislocation.
`28615`	Closed treatment of toe dislocation (single joint)	Performed when closed reduction is successful and no open treatment is required; alternative to `28645`.
`28820`	Arthrodesis, interphalangeal joint, toe; with or without internal fixation	May be performed if joint is irreparably damaged and fusion is required instead of reduction.
`20670`	Removal of foreign body, soft tissue; simple	Performed if soft-tissue interposition or foreign material must be removed during open reduction.
`20680`	Removal of implant; deep (requires removal of deep hardware)	Performed at a later date if internal fixation hardware placed during `28645` requires removal.
`12032`	Repair, muscle, fascia, or tendon (complex)	May be used if associated tendon or soft-tissue repair is required in the operative field (select as clinically appropriate).

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