Podiatry Coding & Billing Alert

Question: The patient had a pilon fracture. My podiatrist fixed the patient’s fibula on the day of his injury and placed a temporary external fixator to stabilize the tibia. Since the patient had severe swelling of tissue, this external fixator allowed inspection of the soft tissue without frequent splint changes. No incision was made through the damaged tissue. Two weeks later, the patient returned to the OR, and my podiatrist removed the external fixator and converted to internal fixation after the soft swelling was reduced. This second procedure was planned ahead of time. What codes should I report on my claim?

Texas Subscriber

Answer: You should report 27826 and 20690 on the first date of service, followed by 27827 on the second date of service. You should append modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) to 27827 because your podiatrist performed the initial fixation with the intent of returning to the OR to convert to internal fixation.

Pilon fractures defined: Pilon fractures, also called a plafond fractures, are fractures 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.

Pilon fractures are complicated, comminuted fractures that have a poor long-term outcome. Pilon fractures may involve complex injuries and several fragments. Since trauma is the most common cause, there can be extensive soft disuse damage and swelling accompanying the fracture.