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The closed treatment of talotarsal joint dislocation, coded as CPT® 28570, refers to a specific medical procedure that addresses dislocations occurring at the talotarsal joint, which is a critical joint in the foot. The talus, one of the seven tarsal bones, plays a vital role in the foot's structure and function, connecting the leg to the foot by articulating with the tibia and fibula above and the calcaneus and navicular bones below. A dislocation at this joint is considered a rare injury and typically involves the talocalcaneal and/or talonavicular joints. During the procedure, the healthcare provider evaluates the neurovascular status of the foot to ensure that blood flow and nerve function are intact. If a pulse is absent, an urgent reduction of the dislocated joint(s) is performed without the need for pre-reduction radiographs. Conversely, if the neurovascular status is stable, separate radiographs are obtained to assess the injury further. The reduction process involves flexing the knee and applying longitudinal traction to the foot while exerting pressure on the talus to realign the joint. After the reduction, the neurovascular status is re-evaluated, and a second set of radiographs is taken to confirm proper alignment. The foot is then immobilized in a splint, and the patient receives instructions to ice and elevate the foot to aid in recovery. It is important to note that CPT® 28570 is specifically used when the dislocation is treated without anesthesia, while CPT® 28575 is designated for cases where anesthesia is required.
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The closed treatment of talotarsal joint dislocation (CPT® 28570) is indicated for patients presenting with a dislocation of the talotarsal joint, which may manifest as severe pain, swelling, and deformity of the foot. The procedure is performed when there is a confirmed dislocation of the talocalcaneal and/or talonavicular joints, and the patient's neurovascular status must be evaluated to determine the urgency of the intervention.
The closed treatment of talotarsal joint dislocation involves several critical steps to ensure proper realignment of the joint. Initially, the healthcare provider evaluates the neurovascular status of the foot to determine if there is adequate blood flow and nerve function. If a pulse is absent, this indicates a potential emergency, and the provider will perform an urgent reduction of the affected joint(s) without obtaining pre-reduction radiographs. In cases where the neurovascular status is intact, the provider will obtain separate radiographs to assess the dislocation accurately. Following this assessment, the knee is flexed, and the provider applies longitudinal traction to the foot while simultaneously exerting pressure on the talus to facilitate the reduction of the dislocated joint. Once the joint is successfully reduced, the neurovascular status is re-evaluated to ensure that blood flow has been restored. A second set of radiographs is then obtained to confirm that the joint is properly aligned. After confirming the successful reduction, the foot is immobilized in a splint to maintain stability during the healing process. The patient is also instructed to ice and elevate the foot to reduce swelling and promote recovery.
After the closed treatment of talotarsal joint dislocation, the patient is expected to follow specific post-procedure care instructions to facilitate healing. The foot is immobilized in a splint to prevent movement and maintain proper alignment of the joint during the recovery period. Patients are advised to apply ice to the affected area to reduce swelling and to elevate the foot to further assist in minimizing edema. Regular follow-up appointments may be necessary to monitor the healing process and to assess the need for further imaging or interventions. Patients should also be educated on signs of complications, such as increased pain, swelling, or changes in neurovascular status, which would require immediate medical attention.
| Short Descr | TREAT FOOT DISLOCATION | Medium Descr | CLOSED TX TALOTARSAL JOINT DISLC W/O ANES | Long Descr | Closed treatment of talotarsal joint dislocation; 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 OPPS relative payment weight. | 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) |
| 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. | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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) | TA | Left foot, great toe |
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