ED Coding and Reimbursement Alert

Question: We saw a patient with a bimalleolar ankle fracture. How should we code this?

Codify Subscriber

Answer: A bimalleolar fracture involves two bones in the ankle region. Your question doesn’t specify whether you are seeking diagnosis or procedure codes, or which services you used to treat the fracture, so we’ll offer a quick breakdown of some of the most common options.

Assuming you performed a repair, you’ll code these fracture repairs with one of the following codes, depending on the encounter notes:

• 27808 (Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); without manipulation)
• 27810 (… with manipulation)
• 27814 (Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli), includes internal fixation, when performed)

The diagnosis code range for bimalleolar fractures is S82.841- (Displaced bimalleolar fracture of right lower leg) through S82.846- (Nondisplaced bimalleolar fracture of unspecified lower leg). The seventh character extension options are:

• A (Initial encounter for closed fracture),
• D (Subsequent encounter for fracture with routine healing),
• G (Subsequent encounter for fracture with delayed healing),
• K (Subsequent encounter for fracture with nonunion),
• P (Subsequent encounter for fracture with malunion), and
• S (Sequela)

Example: A new patient reports to the ED after rolling her left ankle stepping off of a curb. After a level-four evaluation and management (E/M) service and a two-view X-ray, the ED physician diagnoses the patient with a displaced bimalleolar ankle fracture. He then treats the ankle fracture using closed manipulation.

For this claim, you should report:

• 27810 for the ankle repair
• 73600 (Radiologic examination, ankle; 2 views) for the X-ray
• Modifier LT (Left side) appended to 27814 and 73600, if the payer requires it
• 99284 (Emergency department visit for the evaluation and management of a patient…)
• Modifier 57 (Decision for surgery) appended to 99283 to show that the ankle repair and the E/M were separate services
• S82.842A (Displaced bimalleolar fracture of left lower leg, initial encounter for closed fracture) appended to 27808, 73600, and 99283 to represent the patient’s injury