Closed treatment of ankle dislocation performed under anesthesia, with or without percutaneous skeletal pin fixation.

Verified May 8, 2026 · 7 sources ↓

Medicare: $490.99
Total RVUs: 14.7
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCAcgmeAoassn

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Confirm anesthesia type and necessity — document why the reduction required anesthesia (failed conscious sedation, severity, instability, patient factors)
Specify whether percutaneous skeletal fixation was performed and document pin placement details including size, number, and position
Record neurovascular status of the extremity pre- and post-reduction, including pulses, sensation, and motor function
Document pre- and post-reduction imaging confirming the dislocation and the reduction result (fluoroscopic or plain film)
If a concomitant fracture is present, clearly distinguish the dislocation treatment from fracture management in the operative note to support separate coding if applicable
Operative note must name the technique used for reduction — closed manipulative maneuver description, traction method, assistants involved

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 58 Staged or related 73 Discontinued pre-anesthesia 74 Discontinued post-anesthesia 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 27842 covers closed (non-operative) reduction of an ankle dislocation when anesthesia is required, with or without the placement of percutaneous pins to maintain reduction. The anesthesia requirement is the key distinction from 27840, which covers reduction without anesthesia. Both pin placement and the anesthesia itself are bundled into the 27842 package — do not unbundle them.

The 90-day global period means all routine post-reduction care, including follow-up visits, cast changes, and pin removal within 90 days, is included in the surgical package. Anything unrelated to the ankle dislocation billed during that window requires modifier 24 (E&M) or modifier 79 (unrelated procedure). An unplanned return to the OR for a complication directly related to the original reduction uses modifier 78.

When a concomitant ankle fracture (e.g., trimalleolar) is treated at the same operative session, CPT guidelines caution against separately reporting the dislocation if it is inclusive of the fracture code. If the dislocation is genuinely separate and distinct from the fracture being treated, 27842 may be appended with modifier 51, but check CPT section notes for the 27750–27848 range and confirm no NCCI edit applies before billing both. Casting or strapping applied at the conclusion of the procedure cannot be billed separately per NCCI policy.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.3
Practice expense RVU	7.09
Malpractice RVU	1.31
Total RVU	14.7
Medicare national rate	$490.99
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	$490.99
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 27842 get rejected.

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

Billing 27842 alongside a cast or strapping code (e.g., 29581) for the same ankle — NCCI bundles these
Using 27842 when the patient record does not support anesthesia necessity — payers may downcode to 27840
Separately billing 27842 for a dislocation that is inclusive of a concomitant ankle fracture code billed the same session
Missing or insufficient pre- and post-reduction imaging documentation to substantiate the dislocation diagnosis and treatment
Global period violations — billing routine follow-up E&M visits during the 90-day global without modifier 24

Frequently asked questions

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

01What distinguishes 27842 from 27840?

Anesthesia. CPT 27840 covers closed ankle dislocation reduction without anesthesia. Use 27842 when the reduction requires anesthesia — general, regional, or monitored — with or without percutaneous pin fixation. If the record doesn't document anesthesia, expect a downcode to 27840.

02Can I bill 27842 and a fracture code like 27822 together at the same session?

Potentially, but proceed carefully. CPT section guidelines for 27750–27848 state that dislocation treatment is included when the same bone is both fractured and dislocated. If the dislocation is genuinely distinct from the fracture being treated, 27842 with modifier 51 may be appropriate and there are no standing NCCI edits between 27822 and 27842. Confirm with your NCCI lookup tool before billing both.

03Is pin removal during the global period separately billable?

No. Percutaneous pin removal within the 90-day global is included in the surgical package for 27842. If the pins placed at the time of 27842 require removal, that is routine post-op care. CPT codes 20670 or 20680 would apply only when pins are removed as a distinct, separate procedure outside the global or in a different context.

04Can I bill a cast or strapping code alongside 27842?

No. Per CMS NCCI policy, casting, splinting, and strapping cannot be billed separately when a musculoskeletal procedure from the 20100–28899 range is performed for the same anatomic area in the same session. The post-reduction immobilization is part of the 27842 package.

05What modifier applies if the patient returns to the OR for a wound problem related to the original reduction?

Modifier 78 — unplanned return to the OR for a procedure related to the original surgery during the global period. If the return procedure is unrelated to the dislocation treatment, use modifier 79 instead. Do not invert these: 78 is for related complications, 79 is for unrelated procedures.

06Does the site of service affect reimbursement for 27842?

Yes. Hospital Outpatient (HOPD) and ASC payments differ. See the Site of Service comparison table on this page for 2026 values. Physician work RVUs remain the same regardless of setting, but the facility payment varies significantly between HOPD and ASC.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the anesthesia rationale, reduction technique, percutaneous fixation details (pin count, size, placement), and pre/post-reduction neurovascular and imaging findings directly from dictation. This prevents the most common audit flag for 27842 — an operative note that documents a reduction was performed but omits why anesthesia was required or whether pins were placed, leaving payers to downcode to 27840 or deny outright.

See how Mira captures CPT 27842 documentation