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Tarsometatarsal joint dislocation, commonly known as a Lisfranc dislocation, involves the dislocation of the joints between the tarsal bones and the metatarsal bones in the foot. This condition can lead to significant pain and dysfunction if not treated properly. The procedure described by CPT® Code 28600 refers to the closed treatment of this type of dislocation without the use of anesthesia. In this procedure, the healthcare provider first evaluates the neurovascular status of the foot to ensure that blood flow is adequate and that there are no signs of nerve damage. If a pulse is absent, an urgent reduction of the dislocated joint is performed without obtaining pre-reduction radiographs. However, if the neurovascular status is intact, the provider will obtain separate radiographs to assess the extent of the dislocation before proceeding with the closed reduction. The reduction technique involves applying longitudinal traction to the foot while simultaneously exerting pressure on the affected bones to realign them. After the reduction is successfully completed, the neurovascular status is re-evaluated, and a second set of radiographs is taken to confirm proper alignment. The toe is then immobilized using a splint, and the patient receives instructions to ice and elevate the foot to aid in recovery. It is important to use CPT® Code 28600 specifically when the dislocation is treated without anesthesia, while CPT® Code 28605 should be used when anesthesia is required for the procedure.
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The closed treatment of tarsometatarsal joint dislocation is indicated for patients presenting with the following conditions:
The closed treatment of tarsometatarsal joint dislocation involves several critical procedural steps:
Post-procedure care following the closed treatment of tarsometatarsal joint dislocation includes monitoring the immobilized foot for any signs of complications, such as increased pain, swelling, or changes in neurovascular status. Patients are advised to keep the foot elevated and apply ice to manage swelling. Follow-up appointments are necessary to assess healing and to determine when it is appropriate to begin rehabilitation exercises to restore function and strength to the foot. The duration of immobilization and the specifics of rehabilitation will depend on the individual patient's recovery progress and the severity of the dislocation.
| Short Descr | TREAT FOOT DISLOCATION | Medium Descr | CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES | Long Descr | Closed treatment of tarsometatarsal 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) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | 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 | 2 | CCS Clinical Classification | 147 - Treatment, fracture or dislocation of lower extremity (other than hip or femur) |
| 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. | 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). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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. | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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.) | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 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) | T6 | Right foot, second digit | TA | Left foot, great toe | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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