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The CPT® Code 28540 refers to the closed treatment of tarsal bone dislocation, excluding the talotarsal joint, and is performed without the use of anesthesia. The tarsal bones consist of seven individual bones, including the talus, which is not included in this specific procedure. The remaining six tarsal bones are the calcaneus, cuboid, navicular, and three cuneiform bones (medial, intermediate, and lateral). Dislocations of the tarsal bones are considered rare injuries, and the management of such dislocations requires careful evaluation of the neurovascular status of the foot. In cases where a pulse is absent, an emergent reduction of the affected mid-foot joint is necessary, and this may be performed without pre-reduction radiographs. If the neurovascular status is intact, it is essential to obtain separately reportable radiographs to assess the extent of the dislocation. The procedure involves applying longitudinal traction to the foot while exerting pressure on the involved bones to facilitate the reduction of the dislocation. After the reduction is successfully achieved, the neurovascular status is re-evaluated, and a second set of radiographs is obtained to confirm proper alignment. Following the procedure, the foot is immobilized in a splint, and the patient is advised to ice and elevate the foot to aid in recovery. It is important to use code 28540 specifically when the dislocation is treated without anesthesia, while code 28545 should be used when anesthesia is required for the procedure.
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The closed treatment of tarsal bone dislocation, as described by CPT® Code 28540, is indicated for specific conditions related to the dislocation of the tarsal bones, excluding the talotarsal joint. The following indications are relevant for this procedure:
The closed treatment of tarsal bone dislocation involves several critical procedural steps, which are outlined as follows:
After the closed treatment of tarsal bone dislocation, the patient is advised to follow specific post-procedure care instructions. The foot should be immobilized in a splint to ensure stability and prevent further injury during the healing process. Patients are typically instructed to apply ice to the affected area to reduce swelling and to elevate the foot to promote circulation and minimize discomfort. Regular follow-up appointments may be necessary to monitor the healing process and to assess the need for further interventions, such as physical therapy or additional imaging studies. It is essential for patients to adhere to these instructions to facilitate optimal recovery and to avoid complications associated with the dislocation.
| Short Descr | TREAT FOOT DISLOCATION | Medium Descr | CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES | Long Descr | Closed treatment of tarsal bone dislocation, other than talotarsal; without anesthesia | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P6B - Minor procedures - musculoskeletal | MUE | 1 | CCS Clinical Classification | 147 - Treatment, fracture or dislocation of lower extremity (other than hip or femur) |
| 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 54 | Surgical care only: when 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | T3 | Left foot, fourth digit |
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