Open surgical treatment of ankle joint dislocation, with or without percutaneous skeletal fixation, not including ligament repair or internal fixation hardware

Verified May 8, 2026 · 6 sources ↓

Medicare: $675.03
Work RVU: 10.02
Global, days: 90
Region: Foot & ankle

Drawn from CMSNIHEmednyAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative report must specify that the ankle joint was opened via direct incision, not treated closed
Document the dislocation direction and joint surfaces involved, confirmed by pre-op imaging
Explicitly state whether percutaneous pins were placed — and that no internal fixation (plates or screws) was used
Confirm no formal ligament repair was performed; if it was, 27848 is the correct code
Record pre-operative imaging (X-ray or MRI) demonstrating the dislocation
Anesthesia type and surgical positioning must be documented in the operative note

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 50 Bilateral procedure 51 Multiple procedures 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27846 covers open treatment of an ankle dislocation where the surgeon makes an incision to directly visualize and manually reduce the dislocated joint. The key distinction: this code applies when percutaneous pins may be placed for temporary external stabilization, but no internal fixation devices (plates, screws) or formal ligament repair are performed. When the case requires internal or external fixation hardware or ligamentous repair, step up to CPT 27848.

The 90-day global period covers the surgery, the pre-operative visit on the day before, and all routine post-operative management through day 90. Unrelated E/M visits during that window require modifier 24. A separately identifiable same-day E/M requires modifier 25. If the patient returns to the OR within the global for a related complication, bill modifier 78. An unrelated procedure in the same global window gets modifier 79.

Do not separately bill strapping or casting codes (e.g., 29581) when 27846 is also reported for the same anatomic area — NCCI bundles casting and splinting into musculoskeletal treatment codes (20100–28899). Debridement of an open dislocation site may be separately reportable with 11010–11012 if documented and medically necessary, but strapping still cannot stack on top.

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 (10.02) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (20.21) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	10.02
Practice expense RVU	8.28
Malpractice RVU	1.91
Total RVU	20.21
Medicare national rate	$675.03
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	$675.03
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,523.25

Common denial reasons

The recurring reasons claims for CPT 27846 get rejected.

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

Upcoding flag: internal fixation or ligament repair performed but 27846 billed instead of 27848
Strapping or casting code (e.g., 29581) billed same-day for same anatomic area — bundled by NCCI
Lack of imaging documentation confirming dislocation prior to surgical intervention
Global period violation: routine post-op E/M billed without modifier 24 during the 90-day window
Bilateral ankle dislocation treated without modifier 50, causing payer rejection for duplicate service

Frequently asked questions

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

01What's the difference between 27846 and 27848?

27846 is open reduction without internal fixation or ligament repair — percutaneous pins are allowed. 27848 applies when the case includes internal or external fixation hardware or formal ligament repair. The operative note must make this distinction explicit.

02Can I bill a casting or strapping code the same day as 27846?

No. NCCI policy bundles casting, splinting, and strapping into musculoskeletal treatment codes in the 20100–28899 range. Billing 29581 or a similar code with 27846 for the same ankle will be denied.

03If the patient returns to the OR within the 90-day global for a wound complication related to the original surgery, which modifier do I use?

Modifier 78 — unplanned return to the OR for a procedure related to the original surgery within the global period. Modifier 79 is for unrelated procedures. Do not invert them.

04Does 27846 cover bilateral ankle dislocations?

Bilateral cases require modifier 50. Bill a single claim line representing both sides. Most payers reimburse bilateral procedures at 150% of the unilateral fee schedule amount, not 200%.

05Can debridement of an open dislocation site be billed separately with 27846?

Yes, if documented as medically necessary and performed at an open dislocation site. CPT codes 11010–11012 may be reported separately for debridement including foreign material removal. However, no strapping code can stack on top — that remains bundled.

06What ICD-10 diagnosis codes are typically paired with 27846?

S93.0XX codes (dislocation of ankle joint) with the appropriate laterality and encounter type suffix are standard. Use the 'A' suffix for the initial encounter — the surgical encounter is still the initial encounter for ICD-10 purposes.

07Is modifier 22 applicable if the dislocation was particularly complex or required extended operative time?

Yes, but it requires documentation in the operative note explicitly describing the increased complexity — such as severe soft tissue interposition, neurovascular compromise requiring extra dissection, or significantly extended time with a specific reason stated. Modifier 22 without supporting narrative will be denied or ignored.

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 surgical approach, the direct visualization and manual reduction of the ankle joint, whether percutaneous pins were placed, and explicit confirmation that no internal fixation hardware or ligament repair was performed. That distinction is what separates 27846 from 27848 — and it's the most common audit flag on this code pair.

See how Mira captures CPT 27846 documentation