Open surgical repair of an interphalangeal joint dislocation of the toe, including internal fixation when performed.

Verified May 8, 2026 · 6 sources ↓

Medicare: $587.86
Work RVU: 5.48
Global, days: 90
Region: Foot & ankle

Drawn from CMSFastrvuAbosEmednyAAPC

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify which toe (1st through 5th) and which IP joint (proximal or distal) was treated
Confirm open approach — document incision technique and joint exposure in the operative note
State whether internal fixation was used and identify hardware type (K-wire, screw, etc.) and placement
Document the mechanism of injury and pre-operative imaging confirming dislocation
Record neurovascular status of the digit before and after reduction
Note any associated soft-tissue injuries, tendon involvement, or fracture components addressed during the same session

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 52 Reduced services 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 28675 covers open treatment of an interphalangeal (IP) joint dislocation of the toe. This distinguishes it from closed treatment (28660, 28665) and percutaneous fixation (28666) — if the surgeon opens the joint and/or places internal fixation hardware, 28675 is the correct code. The procedure falls under the fracture and dislocation section for the foot and toes and carries a 90-day global period.

The 90-day global bundles the surgery, the day-before pre-op visit, and all routine post-op management through day 90. Separate E/M visits during that window require modifier 24 (unrelated condition) or modifier 25 (significant, separately identifiable service on the day of procedure). If the same surgeon returns to the OR for a related complication — say, hardware failure or wound dehiscence — within the global, bill with modifier 78. An unrelated second procedure in the global period takes modifier 79.

When bilateral IP joint dislocations are corrected at the same session, append modifier 50. If multiple toes on the same foot require open treatment, modifier 51 applies to the secondary code(s). Document each toe and joint by name — payer auditors flag operative notes that reference only 'the toe' without specifying which digit and which joint level.

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 (5.48) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.6) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.48
Practice expense RVU	11.42
Malpractice RVU	0.7
Total RVU	17.6
Medicare national rate	$587.86
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	$587.86
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 28675 get rejected.

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

Operative note fails to confirm open approach, triggering downcoding to closed treatment code 28665
Multiple toes billed without modifier 51 on secondary procedure lines, causing claim rejection
Bilateral repair billed as two separate line items without modifier 50, flagged as duplicate claim
Claim submitted without laterality modifiers (LT/RT) required by payer or facility
Post-op visit billed within the 90-day global without modifier 24 or 25, resulting in bundling denial
Missing or vague imaging documentation; payer cannot confirm dislocation diagnosis prior to open repair

Frequently asked questions

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

01What separates 28675 from 28666?

28666 is percutaneous skeletal fixation with manipulation — no formal joint opening. 28675 requires an open incision with direct joint exposure. If the surgeon opens the joint, 28675 is correct regardless of whether hardware is ultimately placed.

02Can 28675 and 28666 be billed together for different toes on the same foot?

Yes, if one toe required open treatment and a different toe required only percutaneous fixation, both codes are billable. Append modifier 59 to 28666 to indicate a distinct procedural service, and modifier 51 if payer policy requires it on the secondary line.

03Does the 90-day global include the fracture/dislocation follow-up visits?

Yes. All routine post-op care related to the IP joint repair is bundled through day 90. To bill a separate visit during the global, the encounter must address an unrelated condition (modifier 24) or be a significant, separately identifiable service on the surgery date (modifier 25).

04How should bilateral IP joint dislocations be billed?

Bill 28675 once with modifier 50 for bilateral procedures performed at the same session. Most payers reimburse bilateral cases at 150% of the single-procedure rate. Do not submit two separate line items without modifier 50 — that will be flagged as a duplicate.

05Is modifier 22 ever appropriate for 28675?

Yes, when the procedure involves substantially greater work than typical — for example, a severely comminuted periarticular fracture requiring complex reconstruction concurrent with the dislocation repair. Documentation must explicitly describe the increased time, difficulty, and clinical complexity to support the modifier 22 upcharge.

06Which laterality modifiers are required for 28675?

Append LT or RT to identify the operative foot. Most payers and all facility claims require laterality on foot and toe codes. Missing laterality is a common, avoidable rejection — add it before submission.

07If a K-wire placed during 28675 breaks and requires open removal within the global period, how is that billed?

Bill the hardware removal with modifier 78 — unplanned return to the OR for a complication related to the original procedure. Modifier 79 applies only if the return procedure is entirely unrelated to the original surgery.

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 operative approach (open vs. percutaneous), the specific toe and IP joint level, hardware placement details, and neurovascular assessment from dictation. This prevents downcoding to 28665 or 28666 and eliminates audit flags from non-specific joint documentation — the most common reasons open-treatment claims get reduced or denied on review.

See how Mira captures CPT 28675 documentation