Secondary repair or reconstruction of a disrupted collateral ligament of the ankle, performed for chronic instability using tendon transfer or graft augmentation rather than direct suture of the original ligament.

Verified May 8, 2026 · 7 sources ↓

Medicare: $596.87
Total RVUs: 17.87
Global, days: 90
Region: Foot & ankle

Drawn from CMSArthrex Foot/AnkleAAPCKZAABOS

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 7 cited references ↓

Specify chronicity of the injury — acute vs. chronic instability — to justify secondary repair over 27695/27696
Name the specific procedure performed (e.g., Chrisman-Snook, Watson-Jones, anatomic ATFL/CFL reconstruction)
Document whether tendon harvest or graft augmentation was performed, including the donor tendon (e.g., peroneus brevis) and harvest technique
Identify which ligament(s) were reconstructed — ATFL, CFL, or both — with laterality (left vs. right ankle)
Include pre-op diagnosis supporting chronic instability (e.g., ICD-10 M25.371/M25.372 for instability) and failed conservative management
Describe the fixation method — suture anchor placement, drill holes through fibula, soft tissue attachment sites — to support operative complexity

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

27698 covers secondary reconstruction of a disrupted ankle collateral ligament — the operative scenario where the native ligament is no longer directly repairable and the surgeon must use transferred or harvested tendon tissue to restore lateral stability. Classic examples include the Watson-Jones procedure, the Chrisman-Snook reconstruction, and anatomic reconstruction using peroneus brevis graft through the fibula to restore both the ATFL and CFL. The 'secondary' designation does not require a prior surgical repair; per CPT Assistant guidance, it applies any time the injury is chronic or when reconstruction with another tissue is required because the ligament cannot be primarily sutured.

This code sits one step above 27695 (primary repair, single collateral) and 27696 (primary repair, both collaterals) on the complexity and work-RVU scale. If your surgeon is doing a Brostrom-Gould with only direct suture and capsular imbrication — no tendon harvest, no graft — that procedure lives closer to 27695. If tendon mobilization or reconstruction is documented, 27698 is the correct choice. Distinguishing these intraoperatively is the most common coding error in lateral ankle stabilization.

The global period is 90 days. Routine post-op visits, wound checks, and cast changes through day 90 are bundled. Bill modifier 24 for unrelated E/M services and modifier 78 for an unplanned return to the OR for a related complication during the global window. Site of service matters: HOPD and ASC payments differ — see the Site of Service comparison table on this page.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.37
Practice expense RVU	7
Malpractice RVU	1.5
Total RVU	17.87
Medicare national rate	$596.87
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$596.87
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,982.77

Common denial reasons

The recurring reasons claims for CPT 27698 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Operative note says 'standard Brostrom repair' without documenting tendon transfer or graft, leading payers to downcode to 27695
Missing laterality — failure to link LT or RT modifier causes claim suspension or denial under payer edits requiring side designation
Chronic instability not established in documentation — payer denies secondary repair code when records only reference acute sprain without prior conservative treatment failure
Upcoding flag when both ATFL and CFL are reconstructed but coder bills 27696 (primary, both collaterals) instead of 27698 — or vice versa — due to misreading 'secondary' as referring only to the number of ligaments
Global period conflict — post-op visit or injection billed without modifier 24/25 during the 90-day global window triggers automatic denial

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What makes this a 27698 instead of 27695?

27695 is a primary repair — direct suture of an acutely torn collateral ligament. 27698 applies when the injury is chronic or when the surgeon must reconstruct using transferred or grafted tendon because the native ligament cannot be primarily repaired. If your surgeon harvested peroneus brevis or used another tissue source, that's 27698.

02Does 'secondary' mean there was a prior surgery?

No. Per CPT Assistant guidance, 'secondary' in this context means the procedure is performed for a non-acute (chronic) injury or uses another tissue for reconstruction. No prior surgical repair is required to bill 27698.

03Can you bill 27698 for a Brostrom-Gould procedure?

Only if the operative note documents tendon transfer or graft augmentation beyond direct capsular imbrication. A standard Brostrom-Gould using only direct suture and retinacular augmentation without a separate tendon harvest may support 27695 rather than 27698. The operative note must be specific — 'ligament repair' alone is not enough.

04Should I use modifier 50 if both ankles are reconstructed?

Yes. Modifier 50 applies when the identical procedure is performed bilaterally in the same operative session. Bilateral ankle ligament reconstruction is rare but does occur in hyperlaxity or systemic instability cases. Alternatively, bill LT and RT on separate line items per payer preference.

05What modifier do I use if the patient returns to the OR during the 90-day global for a wound complication from this procedure?

Use modifier 78 — unplanned return to the OR for a complication related to the original procedure during the global period. Modifier 79 is for an unrelated procedure. Do not invert these.

06Is the Chrisman-Snook procedure correctly coded as 27698?

Yes. The Chrisman-Snook reconstruction — where peroneus brevis graft is routed through the fibula to reconstruct both the ATFL and CFL — maps to 27698. This was confirmed in AAPC's Orthopedic Coding Alert and aligns with the code's example procedures.

07What ICD-10 codes support medical necessity for 27698?

Chronic lateral ankle instability (M25.371 left, M25.372 right) is the primary driver. Document failed conservative management — physical therapy, bracing — prior to surgical authorization. Acute sprain codes alone will not support secondary reconstruction.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

01CMS Physician Fee Schedule 2026
02CMS 2026 OPPS Final Rule — https://www.cms.gov/files/document/r13575cp.pdf
03Arthrex Foot/Ankle InternalBrace Ligament Augmentation System 2026 Coding and Reimbursement Guidelines — https://www.arthrex.com/resources/DOC1-002101-en-US/foot-ankle-internalbrace-ligament-augmentation-system-2026-coding-and-reimbursement-guidelines
04AAPC Orthopedic Coding Alert: Chrisman-Snook Warrants 27698 — https://www.aapc.com/codes/coding-newsletters/my-orthopedic-coding-alert/reader-question-chrisman-snook-warrants-27698-article
05KZA Coding Coaches: Reconstruction of the ATFL and CFL — https://www.kzanow.com/coding-coaches/reconstruction-of-the-atfl-and-cfl
06AAPC Codify CPT 27698 — https://www.aapc.com/codes/cpt-codes/27698
07ABOS Acceptable CPT Codes for Sports — https://www.abos.org/wp-content/uploads/2019/12/sports-cpt-updated.pdf

Mira AI Scribe

Mira's AI scribe captures the procedure name, chronicity of instability, tendon harvest details, specific ligaments reconstructed (ATFL, CFL, or both), fixation technique, and laterality directly from dictation. That documentation prevents the most common downcode to 27695 — which fires when a note says 'ligament repair' without specifying secondary reconstruction with graft or tendon transfer.

See how Mira captures CPT 27698 documentation