CPT code 28615 – Open treatment of tarsometatarsal joint dislocation

Key takeaways

CPT code 28615 reports open treatment of a tarsometatarsal (Lisfranc) dislocation, and screws, plates, or k-wires placed in the same session are bundled in.

Closed treatment belongs to 28600 or 28605 and percutaneous pinning to 28606, so the approach in the operative note decides the code.

Pair 28615 with S93.324A, S93.325A, or S93.326A, and add an S92 code when a fracture comes with the dislocation.

A diabetic Charcot midfoot is coded to E08-E13 with .610, such as E11.610, while non-diabetic cases use M14.671 or M14.672.

The 90-day global period bundles routine follow-up, and a decision-for-surgery E/M visit on the day of or before surgery takes modifier -57.

What CPT code 28615 means, in plain terms

CPT code 28615 is the code for open treatment of a tarsometatarsal joint dislocation, and it includes internal fixation when the surgeon places it. It sits in the musculoskeletal surgery section of the AMA CPT code set, among the foot and toe fracture and dislocation codes 28400 to 28675.

The official descriptor reads: Open treatment of tarsometatarsal joint dislocation, includes internal fixation when performed. Three conditions have to hold for the code to fit.

• The approach is open. The surgeon makes an incision, directly visualizes the joint, and reduces the dislocation by hand.
• The joint is the tarsometatarsal complex. That’s the articulation between the midfoot tarsal bones and the metatarsal bases, better known as the Lisfranc joint.
• Fixation is part of the package. Screws, plates, or k-wires placed in the same session are bundled, so they never go on a separate line.

Open, closed, or percutaneous: Choosing the right Lisfranc code

Start with the approach, because that’s where most selection errors begin. CPT code 28615 covers complete or partial tarsometatarsal dislocation, with or without a fracture, as long as the joint was opened.

The neighboring codes describe the same joint treated another way, or a different joint entirely. Picking the wrong one leads to downcoding or upcoding flags during claim review.

Open versus closed is the mistake payers catch most often. Billing 28600 or 28605 when the note describes an open approach undervalues the work. Billing 28615 when the note describes percutaneous pinning is an upcoding risk.

Fusion is a separate fork. If the surgeon prepares the joint surfaces and fuses them, the service becomes an arthrodesis. It is reported with 28730 for multiple joints or 28740 for a single joint. The decision path below walks through each fork in order.

What the operative note has to prove

A clean 28615 claim starts in the operating room. Before the note reaches coding, check that it documents each of these elements.

• Approach: Confirm an open incision and direct visualization of the tarsometatarsal joint. A single or dual dorsal incision is typical for Lisfranc injuries.
• Reduction method: Describe the manual reduction, including joint alignment confirmed under fluoroscopy.
• Fixation hardware: Name every implant, with screw diameter, length, and position (for example, “4.0 mm cannulated screw from medial cuneiform to first metatarsal base”).
• Joints addressed: Specify each column reduced and stabilized: medial, middle, and/or lateral.
• Laterality: State left or right foot explicitly. Missing laterality is a common denial trigger.
• Fracture vs pure dislocation: Document any fracture separately, because it changes the diagnosis coding.

Orthopedic and podiatric practices that template the operative note around these fields spend less time answering coder queries. They also send more claims out clean on the first pass.

Which ICD-10 codes support a 28615 claim

The S93.32- subcategory covers subluxation and dislocation of the tarsometatarsal joint. Its dislocation codes are the standard primary pairing for 28615, and each one needs a laterality digit and an encounter character to be billable.

Separate Charcot arthropathy from a traumatic Lisfranc injury before you code. A diabetic patient with a collapsed midfoot may have a Charcot dislocation rather than a traumatic S93.32- injury. Code the diabetic Charcot foot to E08-E13 with .610, such as E11.610 for type 2 diabetes.

Reserve M14.671 or M14.672 for neuropathic arthropathy that isn’t caused by diabetes. Payers apply different medical necessity criteria to neuropathic and traumatic dislocations, so mixing them up leads to coverage denials.

Fracture-dislocation or pure dislocation: Does the code change?

No, the procedure code stays the same. When a tarsal or metatarsal fracture comes with the dislocation, 28615 is still correct as long as the surgeon openly reduces the dislocation.

What changes is the diagnosis coding. Report the S93.32- dislocation code and add the S92 fracture code alongside it. Don’t swap in a fracture-only code, because that removes the indication for 28615 and invites a medical necessity denial.

Charcot cases follow their own path. Use the E08-E13 .610 or M14.67- codes described above instead of the traumatic S93.32- codes. Mixing the two families on one claim is a reliable audit trigger. Before submission, confirm the claim carries every element of a clean claim.

The modifiers that keep a 28615 claim moving

Because 28615 is a major surgical procedure, the modifiers that matter cover complexity, laterality, multiple procedures, and staged work. Each one needs its own supporting documentation.

What 28615 pays under the 2026 fee schedule

Payment for 28615 reflects its status as a major open orthopedic procedure. Under the 2026 Medicare Physician Fee Schedule it carries about 10.43 work RVUs, and rates still vary by setting and locality (GPCI).

Check current figures in the CMS Physician Fee Schedule lookup tool before quoting a payment amount.

Once payment lands, reconcile the electronic remittance advice (ERA) against the contracted rate for each payer. Underpayments on high-value surgical codes slip through easily when posting is manual.

How a 28615 claim moves from scheduling to payment

Most commercial payers cover open Lisfranc reduction when imaging confirms the dislocation and conservative care has been considered. Here is the path a typical claim takes, and the check that belongs at each step.

1. Prior authorization. Confirm the payer’s policy and secure the authorization number before the surgery date.
2. Surgery and dictation. The surgeon documents the approach, reduction, hardware, columns, and laterality.
3. Coding. The coder assigns 28615, the S93.32- diagnosis, any S92 fracture code, and the -RT or -LT modifier.
4. Same-day E/M check. A decision-for-surgery visit that day or the day before goes out with modifier -57.
5. Submission and remittance. The claim goes to the payer, and the ERA is posted against the contracted rate.
6. Global period tracking. Routine visits for the next 90 days are bundled, so only modifier-supported services get billed.

Before you schedule: The prior authorization checklist

Some payers require authorization for elective stabilization, while acute traumatic dislocations usually go through as urgent requests. Have these ready either way.

• Weight-bearing and stress X-rays confirming tarsometatarsal dislocation or instability
• A CT scan or MRI documenting the extent of ligament disruption (many payers require cross-sectional imaging for elective cases)
• Notes on a conservative management trial or, for acute cases, why immediate surgery is medically necessary
• The surgeon’s operative plan, including the approach, expected fixation method, and laterality

Why 28615 claims get denied, and how to prevent it

The same handful of problems causes most 28615 denials. Each one traces back to a step in the walkthrough above.

• Missing or incorrect laterality modifier: Submitting 28615 without -LT or -RT triggers an edit at most Medicare Administrative Contractors. Match the modifier to the ICD-10-CM laterality digit.
• ICD-10 pairing mismatch: A fracture-only code on a documented fracture-dislocation fails, and so does a Charcot code on a traumatic injury.
• Thin operative report: A brief dictation without hardware specifics, approach, or joints addressed often gets suspended for a records request.
• Bundling conflict without -59: When a second foot procedure is done the same day, payers may bundle it unless -59 is appended with independent documentation.
• Same-day E/M without -57: When a pre-operative E/M visit leads to the decision for surgery, it needs modifier -57. The modifier goes on the E/M claim, not on 28615.
• Prior authorization not obtained: For elective cases, a claim without an authorization number denies regardless of clinical justification.

Before you submit: A final claim check

• The operative note says open, and it names every implant and column.
• 28615 carries -RT or -LT, matching the ICD-10 laterality digit.
• The diagnosis is an S93.32- dislocation code, plus S92 for any fracture, or the Charcot code that fits.
• Any same-day E/M carries -57, and any second foot procedure has the documentation for -59.
• The prior authorization number is on the claim.

When a denial does come back, the CARC code on the remittance shows where to start. Our guide to medical billing denial codes explains the common ones and how to respond.

High-volume orthopedic practices benefit from structured denial management workflows that track denial reasons by code and payer. That way the team fixes root causes instead of fighting one-off appeals.

How the 90-day global period shapes follow-up billing

CPT code 28615 carries a 90-day global surgical period under Medicare. Routine post-operative visits in that window are bundled into the surgical fee and can’t be billed separately.

What the package covers, and what it doesn’t

How claims software protects 28615 reimbursement

Lisfranc cases put a dense checklist on the billing team: operative note completeness, ICD-10 pairing, modifiers, prior authorization, and 90 days of global tracking. Centralizing those steps in one system cuts the rework for billing staff.

Pabau, the practice management platform we build, handles this cycle in its claims management software. Eligibility is checked before the date of service. Through the Claim.MD integration, claims route electronically to thousands of US payers, and electronic remittance advice (ERA) comes back for payment reconciliation.

Denial tracking by CPT code and payer shows whether 28615 denials cluster around documentation, one payer’s modifier policy, or missed authorizations. Reviewing the fundamentals of medical billing and the compliance requirements for surgical billing helps you build workflows that hold up in payer audits.

Streamline orthopedic billing from documentation to payment

Pabau connects clinical documentation, claims submission, and payment reconciliation in one platform. See how orthopedic and podiatric practices reduce claim denials and speed up reimbursement cycles.

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Conclusion

Coding 28615 well comes down to one habit: let the operative note decide. If the note proves an open approach, names the hardware, and states the side, the code and modifiers follow without argument.

The trade-off is effort up front. Templating the note and confirming authorization before surgery take time, but they cost far less than chasing a suspended claim later.

To see how Pabau keeps Lisfranc claims, remittances, and denial trends in one place, book a demo with our team.

Continue your research

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Posting surgical payments by hand? Electronic remittance advice (ERA) explains how to read 835 remittance files and reconcile payments against expected rates.

Want to see how RVUs turn into collected revenue? Revenue cycle management covers the end-to-end process from code selection to collected reimbursement.

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Frequently asked questions