Orthopedic Coding Alert

Pinpoint which ankle or foot bone the patient fractured before you bill

If you don't know the difference between the bimalleolar and trimalleolar fracture codes, you could be miscoding to the tune of almost $100-- the difference in reimbursement between the open repair codes for these ankle fractures.
 
You-d be on easy street if physicians could simply document -ankle fracture- and CPT offered a code series for it. But orthopedic surgeons must be specific when documenting fracture repair, and although CPT's index breaks down the ankle fracture code according to whether the fracture is lateral, medial or trimalleolar, the manual gives little direction on bimalleolar, plafond or pilon fractures.
 
Identify Aliases for Each Fracture Type

Lateral malleolus: Even though CPT directs you to the 27786-27814 series for lateral malleolus fractures, your work may not be done, because surgeons don't always dictate -lateral malleolus fractures- in their documentation.
 
In fact, surgeons may document repair of the -distal fibula- when they address the lateral malleolus, says Paul Kosmatka, MD, an orthopedic surgeon at SMDC Orthopedics in Duluth, Minn.
 
For closed fracture treatment of the lateral malleolus, report either 27786 (Closed treatment of distal fibular fracture [lateral malleolus]; without manipulation) or 27788 (- with manipulation). If the surgeon performs open treatment, report 27792 (Open treatment of distal fibular fracture [lateral malleolus], with or without internal or external fixation).
  
 
Medial malleolus: Although most orthopedic surgeons document medial malleolar fractures by name, some physicians use other terms.
 
For instance, surgeons may document a -talus tension- or -talus impact- fracture to describe a medial malleolar fracture -that results from direct impact to the talus or from tension as the talus rotates or moves laterally following the fibula,- says Robert W. Westergan, MD, medical director at Jewett Orthopaedic Clinic PA in Winter Park, Fla.
 
In addition, the term -tibial malleolar- refers to a fracture of the medial malleolus, Westergan says.
 
Some orthopedists may document a -tibial malleolar- fracture because the medial malleolus is at the end of the tibia. If the orthopedist performs closed medial malleolar fracture treatment, report either 27760 (Closed treatment of medial malleolus fracture; without manipulation) or 27762 (... with manipulation, with or without skin or skeletal traction).
 
You should report 27766 (Open treatment of medial malleolus fracture, with or without internal or external fixation) when the orthopedist uses an open method to treat the fracture.

Bimalleolar: You-ll note that CPT directs you to the 27808-27814 series in its index under both the -medial malleolus- and -lateral malleolus- listings. These codes actually represent bimalleolar fractures, which means the patient fractured both the lateral and medial malleoli.
 
You should report 27808 (Closed treatment of bimalleolar ankle fracture [including Potts]; without manipulation) or 27810 (... with manipulation) if the orthopedist performs closed fracture care on a bimalleolar fracture.
 
When the orthopedist uses an open surgical method to treat the bimalleolar fracture, report 27814 (Open treatment of bimalleolar ankle fracture, with or without internal or external fixation) along with 824.4 (Fracture of ankle; bimalleolar, closed) or 824.5 (Fracture of ankle; bimalleolar, open) as the diagnosis.

Trimalleolar: These fractures involve the same components as bimalleolar (medial and lateral) as well as the posterior lip of the tibia. Some physicians may document a -bimalleolar ankle fracture repair, with repair of the posterior malleolus,- but this is simply a trimalleolar fracture repair. -The term -posterior lip- is synonymous with -posterior malleolus,- - Kosmatka says.
 
In addition, if the surgeon documents a -Henderson fracture,- he's referring to a trimalleolar fracture repair, Westergan says.
 
If the orthopedist performs a closed treatment, report 27816 (Closed treatment of trimalleolar ankle fracture; without manipulation) or 27818 (... with manipulation), along with the diagnosis code 824.6 (Fracture of ankle; trimalleolar, closed) or 824.7 (Fracture of ankle; trimalleolar, open).
 
You should use 27822 (Open treatment of trimalleolar ankle fracture, with or without internal or external fixation, medial and/or lateral malleolus; without fixation of posterior lip) or 27823 (... with fixation of posterior lip) for open trimalleolar treatments.