Fracture care · Foot & ankle

27840

Closed reduction of a dislocated ankle joint performed without anesthesia and without surgical incision.

Verified May 8, 2026 · 5 sources ↓

Medicare
$452.92
Total RVUs
13.56
Global, days
90
Region
Foot & ankle
Drawn from CMSAshlinkJposnaAcgme

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

  • Confirm no anesthesia was used — documentation must distinguish this from 27842, which requires anesthesia
  • Record mechanism of injury (e.g., forced plantar flexion, sports trauma) and clinical findings supporting dislocation diagnosis
  • Document pre- and post-reduction neurovascular status of the foot and ankle
  • Specify laterality (left or right) in both the operative note and the ICD-10 code selection
  • Note whether post-reduction imaging was obtained; if you own the equipment and interpret the films, a separate report is required — CMS NCCI bars separately billing the professional component of post-reduction confirmatory imaging
  • Record the reduction technique and any immobilization applied (splint type, position, material)

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 26 Professional component 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 27840 covers closed treatment of an ankle dislocation performed without anesthesia. No incision is made; the physician manually reduces the joint using external manipulation. This distinguishes it from 27842, which requires anesthesia (with or without percutaneous fixation), and from 27846/27848, which are open procedures.

27840 carries a 90-day global period. That window covers the reduction itself, the day-before visit if applicable, and all routine follow-up through day 90 — including splint checks, wound checks, and cast changes. Replacement casts and splints, supplies, and separately interpreted imaging are billable outside the global. If you billed a significant, separately documented E/M on the same day as the reduction, append modifier 25 to the E/M.

ICD-10 codes in the S93.01–S93.06 family (subluxation or dislocation of ankle joint, with appropriate encounter suffix) are the primary diagnosis matches. The encounter suffix matters: initial encounter (A), subsequent (D), or sequela (S). Payers will reject a claim coded with suffix A on a follow-up visit that should carry suffix D.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU4.65
Practice expense RVU7.83
Malpractice RVU1.08
Total RVU13.56
Medicare national rate$452.92
Global period90 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

SettingMedicare rate (national)
Office (PFS non-facility)
Procedure performed in physician's office
$452.92
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 27840 get rejected.

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

  • Wrong ICD-10 encounter suffix — billing suffix A (initial encounter) on a follow-up visit triggers automatic denial
  • Unbundling post-reduction imaging professional component — CMS NCCI policy prohibits separately reporting the professional component of confirmatory post-reduction imaging
  • Upcoding to 27842 without documentation that anesthesia was administered — payers audit this distinction closely
  • Missing laterality in the diagnosis code — unspecified laterality codes draw edit flags from many commercial payers
  • Billing a separate E/M on the same date without modifier 25 — the E/M collapses into the global without it

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What is the difference between 27840 and 27842?
The single deciding factor is anesthesia. 27840 is closed treatment without anesthesia. 27842 is closed treatment requiring anesthesia, with or without percutaneous skeletal fixation. If your operative note documents administration of any anesthetic agent, 27842 is the correct code — and it has a higher RVU value. Billing 27840 when anesthesia was used undercodes the service.
02Can I separately bill for the post-reduction X-ray?
The technical component (facility-owned equipment) may be separately reported. The professional component — your interpretation — is not separately payable under CMS NCCI policy when the imaging is confirmatory post-reduction. If a commercial payer applies NCCI guidelines, the professional component is also blocked. Always check payer-specific policy, but assume Medicare and Medicaid block the 26-modifier interpretation.
03Does the 90-day global include follow-up casting and splint changes?
Routine follow-up is included. Replacement casts and splints, and their associated supplies, are billable separately outside the global. The original E/M that led to the procedure decision can be billed with modifier 57 if it was a significant decision-for-surgery visit, or modifier 25 if it was a separate, distinctly documented E/M on the same day as the procedure.
04Which ICD-10 codes support 27840?
The primary family is S93.01XA through S93.06XS — subluxation or dislocation of the ankle joint. The encounter suffix is critical: A for initial encounter, D for subsequent encounter, S for sequela. Using suffix A on a follow-up visit will trigger denial. Laterality must be specified (left, right, or unspecified — though unspecified invites edits from many payers).
05If the reduction fails and I need to proceed to open treatment the same day, how do I code that?
Report only the open treatment code (27846 or 27848 depending on whether internal fixation is used). Do not stack 27840 and an open code for the same anatomic site on the same date — the closed attempt is bundled into the definitive open procedure. Document the failed closed reduction attempt in the operative note to support medical necessity for the open approach.
06Can two surgeons of different specialties co-bill 27840 with modifier 62?
Modifier 62 (co-surgery) applies when two surgeons of different specialties operate simultaneously on the same patient in the same session. Closed ankle dislocation reduction is rarely a co-surgery scenario. If a podiatrist and an orthopedic surgeon are genuinely co-managing the same reduction simultaneously, modifier 62 is technically available, but expect payer scrutiny — document each surgeon's distinct intraoperative role clearly.

Sources & references

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

  1. 01CMS Physician Fee Schedule 2026
  2. 02
    ashlink.com
    https://www.ashlink.com/ASH/WCMGenerated/CPG_258_Revision_9_-_S_tcm17-113564.pdf
  3. 03
    cms.gov
    https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-add-code-edits
  4. 04
    jposna.org
    https://www.jposna.org/index.php/jposna/article/download/288/215/1802
  5. 05
    acgme.org
    https://www.acgme.org/globalassets/pfassets/programresources/262_caselogguidelines_footandankleos.pdf

Mira AI Scribe

Mira's AI scribe captures the reduction technique, confirmation that no anesthesia was used, pre- and post-reduction neurovascular exam findings, laterality, immobilization type and position, and the ICD-10 encounter suffix from the physician's dictation. This prevents the most common 27840 denial: a mismatched encounter suffix or an anesthesia field left blank that triggers an automatic downcode to 27842 review.

See how Mira captures CPT 27840 documentation

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