Orthopedic Coding Alert

Question: What is the right code for distal tibia and fibula ORIF? The surgeon made two incisions with about 8 cm skin bridge between the 2 incisions and separate plates and screws were placed. Is it correct to report 27829?

Answer: We need more specific information about the fracture in order to assign the correct code. Code 27829 (Open treatment of distal tibiofibular joint [syndesmosis] disruption, includes internal fixation, when performed) does not apply as a syndesmosis disruption is not mentioned in the question. We don't even know whether hardware was applied to the tibia, fibula, or both bones. If this is an ORIF of a bimalleolar fracture, report code 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); if it is an ORIF of distal shaft fracture, report 27758 (Open treatment of tibial shaft fracture [with or without fibular fracture], with plate/screws, with or without cerclage); if it is an ORIF of a pilon fracture, it would be 27826 (Open treatment of fracture of weight bearing articular surface/portion of distal tibia [eg, pilon or tibial plafond], with internal fixation, when performed; of fibula only), 27827 (Open treatment of fracture of weight bearing articular surface/portion of distal tibia [eg, pilon or tibial plafond], with internal fixation, when performed; of tibia only), or 27828 (Open treatment of fracture of weight bearing articular surface/portion of distal tibia [eg, pilon or tibial plafond], with internal fixation, when performed; of both tibia and fibula), depending upon which bone(s) were fixed with the plate and screws.