ED Coding and Reimbursement Alert

Question: If the ED physician performed fracture care without manipulation on the patient's posterior malleolus, which CPT should we report? There appears to be no specific code for this.


Arkansas Subscriber

Answer: You are correct in your assessment that there is no specific code to describe the emergency department physician's treatment of an isolated fracture of the posterior malleolus (which is a portion of the tibia).

Because the posterior malleolus is part of the tibia, the medial malleolus code (27760, Closed treatment of medial malleolus fracture; without manipulation) is the most appropriate choice to represent this service.

CPT divides the code set for closed treatment of ankle fractures based on two criteria: the bones involved, and whether one, two or three aspects of the ankle's supportive bony structure are injured.

The two bones in the lower leg are the fibula and tibia. A patient can have an isolated fracture of the distal fibula (the lateral malleolus) or an isolated fracture of the distal tibia (the medial malleolus).

A bimalleolar fracture (two bones) involves both the medial and lateral malleoli, and a trimalleolar fracture (three bones) involves the medial, lateral, and posterior malleoli.