Podiatry Coding & Billing Alert

Hint: Don't forget about syndesmotic injuries.

You have a lot to remember when it comes to reporting treatment for various types of ankle fractures. For example, does the medical documentation indicate if the injury is a medial malleolus fracture? Or is it a lateral malleolus fracture? Did the podiatrist use open or closed treatment?

Read on to strengthen your ankle fracture coding knowledge and to protect your podiatry reimbursement.

First, Distinguish Between Open Versus Closed Fracture Treatment

Open fracture treatment: When the site of the fracture is exposed to do a surgical repair, that's referred to as an "open" treatment. Open treatment is used when the fractured bone is either surgically opened to visualize or fix the fracture, or is opened remote from the fracture site in order to insert an intramedullary nail across the fracture site.

Closed fracture treatment: If the fracture site is not surgically exposed to the external environment and directly visualized, it is referred to as a "closed" treatment. In a closed treatment, the fracture is reduced without any exploration.

Delve Into Choices for Medial Malleolus Fracture Treatment

When a patient has a medial malleolus fracture, he fractures the inner side of his ankle at the end of the tibia. You should report the following codes for closed medial malleolus fracture treatment:

• For closed treatment, report either 27760 (Closed treatment of medial malleolus fracture; without manipulation) or 27762 (...  with manipulation, with or without skin or skeletal traction).
• For open treatment, report 27766 (Open treatment of medial malleolus fracture, includes internal fixation, when performed).

For example, your podiatrist needs to surgically visualize a medial malleolus fracture. Because this required exposure to the environment, you would report 27766.

Focus on Posterior Malleolus Fracture Codes

When a patient has a posterior malleolus fracture, he has a fracture at the distal posterior aspect of the tibia. Report the following codes for posterior malleolus fracture treatment:

• For closed treatment, report either 27767 (Closed treatment of posterior malleolus fracture; without manipulation) or 27768 (...  with manipulation).
• For open treatment, report 27769 (Open treatment of posterior malleolus fracture, includes internal fixation, when performed).

For example, the podiatrist treats the posterior malleolus fracture without manipulation. He did not surgically expose the fracture site to the external environment, and he reduced the fracture without any exploration. You would report 27767 for this service.

Discover Trimalleolar Fracture Options

Similar to a bimalleolar fracture because it also involves the medial malleolus and lateral malleolus, a trimalleolar fracture additionally includes a posterior malleolus fracture. You should report the following codes for trimalleolar fracture care:

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

Don't miss: When the posterior lip does not require fixation, submit 27822. Otherwise, when the podiatrist needs to fix the tibial posterior lip, report 27823.

Patient has Pilon/Plafond Fracture? Look to These 5 Codes

A Pilon fracture, also called a Plafond fracture, is a fracture of the distal part of the tibia, involving its articular surface at the ankle joint. Pilon fractures are caused by rotational or axial forces, usually a result of falls from a height or car accidents. You should report the following codes for Pilon/Plafond fracture care:

• For closed treatment, report 27824 (Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia; without manipulation) or
• 27825 (... with skeletal traction and/or requiring manipulation). Note: An external fixator is often applied for stabilization of a pilon fracture after closed reduction when future open treatment is planned.
• For open treatment, report 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 (... of tibia only), or 27828 (... of both tibia and fibula).

Pilon fractures are more complicated, comminuted fractures that have a poor long-term outcome, says Jordan Meyers, DPM, partner at Raleigh Foot and Ankle Center and consultant at Treace Medical Concepts, Inc. in Raleigh, North Carolina.

Consider Syndesmotic Injuries When Reporting Fractures

Syndesmotic injuries defined: The point just above the ankle where the tibia and fibula meet is called the syndesmosis. The syndesmosis provides stability to the ankle joint and allows motion of the joint. A patient can injure his syndesmosis by twisting it or experiencing a rotational injury to his ankle. When an injury like this occurs, the ligaments supporting the syndesmosis are stretched or torn.

"While not a fracture, a syndesmotic injury can be seen concomitantly with one or more fractures," says Ashley Nettles, DPM, podiatrist at William Jennings Bryan Dorn VA Medical Center in Columbia, South Carolina. "When there is one or more fractures with a syndesmotic injury, it is extremely unstable."