Orthopedic Coding Alert

Knowing bimalleolar, trimalleolar differences is vital.

Coders prepping a claim for an ankle fracture repair will want to be sure that they have some foreknowledge of fracture types, as well as the different repair options, before choosing codes.

Failure to grasp these coding specifics could result in lost reimbursement, overcoding, and more headaches — so be sure to get it right the first time.

For more information on how to file the cleanest ankle fracture repair claim possible, check out this expert advice on breaking through any fracture repair coding walls that might stand in your way.

Bimalleolar = 2 Bones

The first injury we’ll tackle is a bimalleolar ankle fracture. 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).

Characteristics: According to Lynn M. Anderanin, CPC, CPMA, CPPM, CPC-I, COSC, senior director of coding education at Healthcare Information Services in Park Ridge, Illinois, “a bimalleolar ankle fracture will involve two bones: the medial, distal, end of the tibia — or medial malleolus; and the distal, outside, end of the fibula — or lateral malleolus.” Additionally, a bimalleolar fracture can also be a break of the medial and posterior malleoli or the lateral and posterior malleoli.

When encounter notes indicate that the patient suffered a fracture to the bones listed above, be on the lookout for a bimalleolar ankle fix coding opportunity.

Lean on These Dx Codes for Bimalleolar Breaks

The diagnoses 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 orthopedist after rolling her left ankle stepping off of a curb. After a level-four evaluation and management (E/M) service and a 2-view x-ray, the orthopedist diagnoses displaced bimalleolar ankle fracture. He then repairs the ankle using closed treatment.

For this claim, you should report:

• 27808 for the ankle fix.
• 73600 (Radiologic examination, ankle; 2 views) for the x-ray.
• Modifier LT (Left side) appended to 27814 and 73600, if the payer requires it.
• 99204 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination;
• Medical decision making of moderate complexity …) for the E/M service.
• Modifier 57 (Decision for surgery) appended to 99204 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 99204 to represent the patient’s injury.

Trimalleolar = 3 Bones

Your orthopedist might also perform a repair for trimalleolar ankle fractures. When this occurs, you’ll choose from one of the following codes, depending on encounter specifics:

• 27816 (Closed treatment of trimalleolar ankle fracture; without manipulation)
• 27818 (… with manipulation)
• 27822 (Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; without fixation of posterior lip)
• 27823 (… with fixation of posterior lip).

Characteristics: According to Anderanin, “a trimalleolar fracture is a bimalleolar fracture with the addition of a fracture to the posterior portion of the tibia. his bone is sometimes called the posterior malleolus.

“There can be ligament damage in addition of these fractured bones in many cases, again caused by a twisting or rolling of an ankle,” adds Anderanin.

Try to Remember These Dx Codes for Trimalleolar Breaks

The ICD-10 code range for trimalleolar fractures is S82.851- (Displaced trimalleolar fracture of right lower leg) through S82.856- (Nondisplaced trimalleolar fracture of unspecified lower leg); as with bimalleolar fractures, the seventh-character extensions for trimalleolar fractures are A,D,G,K,P, and S.

Example: An established patient reports to the orthopedist after suffering a right ankle injury after falling from a scaffolding. After a level-three E/M service and a three-view ankle x-ray, the orthopedist diagnoses a displaced right trimalleolar ankle fracture. She then repairs the break using closed treatment and manipulation.

On this claim, you would report:

• 27818 for the fracture repair.
• 73610 (… complete, minimum of 3 views) for the x-ray.
• 99203 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity …) for the E/M.
• Modifier 57 appended to 99203 to show that the E/M and the surgery were separate services.
• S82.851A (Displaced trimalleolar fracture of right lower leg, initial encounter for closed fracture) appended to 27818, 73610, and 99203 to represent the patient’s injury.