Orthopedic Coding Alert

Find out what -medial malleolus and distal fibular fracture- really means If you limit 27808-27814 to lateral and medial malleoli fractures, you-re risking errors on your claims. Clear up the confusion with this look at all the bimalleolar and trimalleolar CPT and ICD-9 details. Report Bimalleolar for Any 2 Malleoli If a patient has a bimalleolar fracture, she has fractured two malleoli (rounded protuberances on each side of the ankle), as the examples in 27808-27814's code descriptors indicate: - 27808 -- Closed treatment of bimalleolar ankle fracture (e.g., 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 (e.g., lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli), includes internal fixation, when performed. You probably see lateral and medial bimalleolar fractures most often, but including posterior malleoli in the description simply describes a less common possibility, explains Shelly Ghrist, CPC, assistant manager of Wolf Creek Medical Associates in Pennsylvania. CPT added the examples to the descriptors in 2008. The change is helpful because CPT didn't spell out which code to use for a bimalleolar fracture involving the posterior malleolus before, Ghrist says. And, according to the AMA's CPT Changes 2008, that was the revision's intent -- "to describe all patterns and combinations of bimalleolar fractures and to assist in accuracy of code selection." Opt for 27814 for Bimalleolar ORIF As the descriptors also indicate, you should choose 27808 and 27810 for closed bimalleolar treatment. But, you may be more likely to see the surgeon choose open reduction, internal fixation (ORIF) for bimalleolar fractures, says Chris Ford with the billing department of Coastal Orthopedics and Sports Medicine Group in Oceanside, Calif. You should report this bimalleolar ORIF procedure with 27814, notes Ford, who frequently sees this treatment at her practice. 27814 tip: CPT 2008 adjusted the 27814 descriptor to state "includes internal fixation when performed" to clarify that the code includes internal fixation, but you may report external fixation separately (20690-20692), states CPT Changes 2008. Choose 824.4 for Pott's and More To prove medical necessity for 27808-27814, payers require you to submit an appropriate diagnosis code. The codes describing bimalleolar fractures are 824.4 (Fracture of ankle; bimalleolar, closed) and 824.5 (Fracture of ankle; bimalleolar, open). Pott's change explained: Before the 2008 CPT change, the 27808 and 27810 descriptors stated, "Closed treatment of bimalleolar ankle fracture (including Potts) -" You may not see the term Pott's very much any more, but it is a type of bimalleolar fracture, explains Ford. So even though CPT removed the term "Potts" from the 2008 CPT code descriptors, you should [...]