This really is not a normal foot & ankle surgery that you see. I would say trimming the skin is incidental. Notice that your physician cut the capsule open. I'm thinking that this was performed mostly to rule out infection. Anything that your doctor cuts you can't bill for repairing it. If they cut it, they have to repair it. But due to instability your doctor is performing a procedure where the joint capsule is put back together "tighter" than it would normally be. Your doctor may have performed an imbrication type of procedure for this, but they really don't say. Making the capsule tighter is the restorative procedure in this case. That would be unlisted 27899. I would also say that modifier -58 would be used since your doctor knew that they would be returning to perform a procedure. With a severe dislocation it's probable that the collateral ligament/s where probably stretched out. Was a collateral ligament or two repaired? Possibly but if so it's really not clear in the documentation. After the swelling goes down the patient will return for closure. I hope this helps.