# tibia Salter-Harris I displaced fx & segmental fibular fx



## phillirk (Apr 10, 2013)

My surgeon thought we could only code for the tibia, CPT 27824.  Am I able to code for both fractures?  Do I need to use a modifier since the patient was seen elsewhere prior? 

POSTOPERATIVE DIAGNOSIS:  Right tibia Salter-Harris I displaced fracture and a segmental fibular fracture.

PROCEDURE PERFORMED:  Closed manipulation and long leg casting of right distal tibia and fibula fracture.

INDICATIONS FOR PROCEDURE:  Male sustained a significant 100% displaced tibia Salter-Harris I fracture of a tibial plafond and a segmental fibula fracture.  He was close reduced elsewhere the night of the injury and had incomplete reduction.  He presents today for reduction and casting.  

DESCRIPTION OF PROCEDURE:  Patient was brought into operating suite where general anesthetic was performed.  His split was removed.  His skin was intact.  He was mildly swollen.  A gentle longitudinal traction was performed with a little bit of varus force to the foot and inversion.  This gave a much better alignment of his distal tibial physis.  A well molded short leg plaster cast was applied.  He was still in slight valgus and his fibula approximation was good but also in more of a bayonet apposition.  It was felt that since he had a previous reduction a few days prior that further attempt at reduction would have a deleterious effect on the grown plate.  This cast was then made into a long leg cast.  The patient was awakened….

Thank you.


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## phillirk (Apr 15, 2013)

*Recommended Answer*

Since the MD is taking responsibility for the treatment of both bones, instead of trying to select one code that really doesn't give an accurate description of what he did to both the tibia and the fibula, two separate CPT codes are recommended.

CPT 27825 (Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia; with skeletal traction and/or requiring manipulation).  

CPT 27786-51 (Closed treatment of distal fibular fracture (lateral malleolus), without manipulation).


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