Podiatry Coding & Billing Alert

Question: My podiatrist wrote an op note that described treating a medial malleolar fracture. I am not sure which CPT or ICD-9 code to select since several codes seem to apply. Can you help?

Wisconsin Subscriber

Answer: For repair or medial malleolar fractures, you need to determine if the podiatrist used a closed or open method.

Closed: Closed treatment means the fracture site is not surgically opened (exposed to the external environment and directly visible). If the podiatrist 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) with 824.0 (Fractures of ankle, medial malleolus, closed) or 824.1 (Fractures of ankle, medial malleolus, open) as the diagnosis.

Open: Open treatment means the fracture is surgically opened and visible (internal fixation may or may not be used), or the fractured bone is opened remotely from the fracture site to insert an intramedullary (IM) nail across the fracture site. To code the open treatment, a surgical opening needs to be made. You should report 27766 (Open treatment of medial malleolus fracture, includes internal fixation when performed) with when the podiatrist uses an open method to treat the fracture.

New option: You may come across a podiatrist treating medial malleolus fractures with closed manipulation and percutaneous fixation, but there is no CPT code for this procedure. You would need to bill this method with an unlisted procedure code (27899, Unlisted procedure, leg or ankle). Be sure to include the op note, a description of the procedure, and a letter describing a omparable established procedure.

-- Answers to You Be the Coder and Reader Questions were reviewed by Arnold Beresh, DPM, CPC, of Peninsula Foot and Ankle Specialists PLC in Hampton, Va., and Richard Odom, DPM, CPC, AOPS, practicing podiatrist at Gulf Coast VA Hospital System in Mobile, Ala.