Closed reduction of proximal tibiofibular joint dislocation performed without anesthesia.

Verified May 8, 2026 · 6 sources ↓

Medicare: $435.21
Work RVU: 3.86
Global, days: 90
Region: Knee

Drawn from CMSAAPCEohhsEmednyFindacode

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm dislocation of the proximal tibiofibular joint specifically — not the distal joint or ankle syndesmosis
Document that the reduction was performed without anesthesia (local, regional, or general)
Record pre- and post-reduction neurovascular status of the limb, including peroneal nerve assessment
Include imaging (X-ray or CT) confirming the dislocation and post-reduction joint alignment
Note the mechanism of injury and laterality (left vs. right)
Document that no surgical incision, internal fixation, or external fixator was applied

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27830 describes closed (nonsurgical) realignment of the proximal tibiofibular joint — the articulation between the fibula head and the lateral tibial plateau, just below the knee. No incision is made, no anesthesia is administered, and no internal or external fixation is placed. The physician manually restores joint congruity through external manipulation.

The 90-day global period applies. All routine follow-up visits, splint checks, and neurovascular assessments through day 90 are bundled. If anesthesia becomes necessary during the encounter, step up to 27831. If open reduction or fixation is ultimately required, 27832 is the correct code.

The proximal tibiofibular joint is uncommon territory — dislocations here are frequently missed on initial presentation. Documentation must clearly distinguish the joint involved (proximal vs. distal tibiofibular) and confirm that no anesthesia was used. Conflating this injury with ankle syndesmosis disruption (27829) or distal tibiofibular instability is a common coding error that triggers downcoding or denial.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (3.86) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (13.03) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	3.86
Practice expense RVU	8.34
Malpractice RVU	0.83
Total RVU	13.03
Medicare national rate	$435.21
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	$435.21
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI A2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 27830 get rejected.

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

Incorrect code selection — 27829 (distal tibiofibular syndesmosis) billed instead of 27830 for a proximal joint injury
Anesthesia administered during the encounter without upcoding to 27831, triggering payer audit or downcoding
Missing post-reduction imaging documentation to support medical necessity of the reduction
Laterality not specified in operative or procedure note, causing claim rejection under payers requiring LT/RT
Global period conflict — E/M billed within 90-day post-op window without modifier 24 for an unrelated visit

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What's the difference between 27830, 27831, and 27832?

All three treat proximal tibiofibular joint dislocation. 27830 is closed reduction without anesthesia. 27831 is closed reduction requiring anesthesia. 27832 is open reduction, with or without internal or external fixation. Bill the code that matches what was actually done — if anesthesia was used, 27830 is wrong.

02How is 27830 different from 27829?

27829 covers open treatment of the distal tibiofibular joint (syndesmosis disruption) with internal fixation — a completely different anatomic site and surgical approach. 27830 is closed reduction of the proximal tibiofibular joint without anesthesia. Mixing these up is one of the most common coding errors for lower leg dislocation claims.

03Do I need modifier LT or RT for 27830?

Most commercial payers and many MACs require laterality modifiers on unilateral extremity procedures. Append LT or RT. Bilateral proximal tibiofibular dislocation is anatomically rare — if billing both sides, add modifier 50 and document each side independently.

04What triggers the 90-day global period, and what's bundled?

The 90-day global starts on the day of the procedure. Bundled services include the day-before pre-op visit, the procedure itself, and all routine post-op visits, splint adjustments, and neurovascular checks through day 90. Bill modifier 24 for unrelated E/M visits and modifier 79 for unrelated procedures performed in the global window.

05If the patient requires anesthesia mid-procedure, can I still bill 27830?

No. If anesthesia (local infiltration, regional block, or general) was required to complete the reduction, bill 27831 instead. 27830 is specifically for reductions performed without any anesthesia. Billing 27830 when anesthesia was documented is a supported audit finding.

06Is post-reduction imaging required for billing 27830?

CMS does not mandate specific imaging as a billing prerequisite, but medical necessity documentation is required. Pre- and post-reduction X-rays are standard of care for this injury and are the primary evidence auditors look for to support the dislocation diagnosis and confirm successful reduction. Missing imaging is a frequent trigger for medical necessity denials.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the joint name (proximal tibiofibular, not distal or syndesmosis), confirms no anesthesia was used, logs the reduction maneuver, and records pre- and post-reduction neurovascular findings including peroneal nerve status. This prevents the most common denial trigger — documentation that doesn't distinguish the proximal from the distal tibiofibular joint, which leads auditors or coders to flag the claim for incorrect code selection or upcoding to 27831.

See how Mira captures CPT 27830 documentation