# Question about closed tx of dislocation



## cindya4271@gmail.com (Mar 11, 2014)

Hi everyone-
My provider performed an ORIF of Trimalleolar ankle fracture and also closed treatment of ankle dislocation. She wanted to use 27822 and 27840.. but the 27840 is for closed treatment without anesthesia. She performed it at the same time as the 27822 so the patient was under anesthesia.


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## nrichard (Mar 11, 2014)

*It?s 27822 & 27842*

28742 is ?closed treatment of ankle dislocation requiring anesthesia, with or without percutanous pins. 
There is no NCCI edits, so these codes can be billed together with modifier 51 on 27842.


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## OCD_coder (Mar 11, 2014)

nrichard there would not be an NCCI edit if there are CPT inclusion notes of:
(please do not bill for a dislocation of the same ankle, it is inclusive per the CPT guidelines)

*Section Notes - 27750-27848 Treatment of Fracture/Dislocation Lower Leg/Ankle - (27750-27848) Treatment of Fracture/Dislocation Lower Leg/Ankle*

EXCLUDES:

epiphyseal arrest of proximal tibia and fibula (27477)

INCLUDES:Treatment of open or closed fracture or dislocation


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## nrichard (Mar 11, 2014)

That was my original thought too. The other codes in the defined range of 27750-27848 are clearly labeled when manipulation is performed. 27822 does not specify "with manipulation"
Can you point me to where, at in CPT, I would find that guideline?


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## OCD_coder (Mar 11, 2014)

I have encoder pro, it was copied directly from there into this forum.  I also have Optum's version of the CPT book and the guidelines are a little more detailed.

*AAPC View*~
_For both procedural and diagnostic coding, experts generally agree that if one bone is both fractured and dislocated, code only the service and diagnosis for the fracture and not the dislocation (see Coding Clinic, third quarter 1990, page 13). Some CPT? codes specifically describe surgeries on a bone that is both fractured and dislocated_.
http://news.aapc.com/index.php/2013/03/fine-details-are-critical-in-fracture-coding/

27822, partial procedure description....
_One at a time, the physician restores the fractured pieces to their correct positions._ - This is the definition of "manipulation."

?? internal fixation is manipulation, not sure why they would need to re-state something.....


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