Podiatry Coding & Billing Alert

You Be the Coder:

Distinguish Between Bimalleolar and Trimalleolar Fractures

Published on Fri Mar 19, 2021

Question: I’m new to coding, and I’m having trouble understanding the difference between different types of ankle fractures. For example, what is the difference between a bimalleolar ankle fracture and a trimalleolar fracture? Which CPT^® codes should I report for these types of fractures?

California Subscriber

Answer: A bimalleolar ankle fracture involves two bones: the medial, distal, end of the tibia — or medial malleolus; and the distal, outside, end of the fibula — or lateral malleolus. A bimalleolar fracture can also be a break of the medial and posterior malleoli or the lateral and posterior malleoli.

You should report the following CPT^® codes for bimalleolar fracture treatment:

For closed treatment, report 27808 (Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); without manipulation) or 27810 (... with manipulation).
For open treatment, report 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).

Although a trimalleolar fracture is 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, report 27822. Otherwise, when the podiatrist needs to fix the tibial posterior lip, report 27823.