Orthopedic Coding Alert

Question: Which CPT codes should I report when the surgeon performs two manipulations under general anesthesia -- one for the right ankle joint and one for the right subtalar joint?

South Carolina Subscriber

Answer: For the ankle manipulation, you should report 27860 (Manipulation of ankle under general anesthesia [includes application of traction or other fixation apparatus]).

For the subtalar joint, you won't find a specific manipulation code, so 28575 (Closed treatment of talotarsal joint dislocation; requiring anesthesia) or 28899 (Unlisted procedure, foot or toes) may be appropriate.

Watch out: You should not report 28575 unless the surgeon treats a dislocation. If the pathology is arthrofibrosis, for example, you should report the unlisted-procedure code and use 28575 as a comparison code for reimbursement.

The subtalar joint sits just below the ankle joint where the talus (which sits between the heel and lower leg bones) and calcaneus (heel bone) meet. Surgeons may also call the subtalar joint a talocalcaneal joint.

Tip: CPT defines manipulation as "the attempted reduction or restoration of a fracture or joint dislocation to its normal alignment by the application of manually applied forces." Closed treatment may involve manipulation, but CPT does not require it.