I need some assistance with some ankle fracture coding. In my experience I have always been told to code fractures based on diagnosis. So if there is a bimalleolar ankle fracture then you code with a bimalleolar CPT code. If it a trimalleolar ankle fracture then you use a trimalleolar CPT code. In the wording for these CPT codes it says "includes fixation, when performed" so this makes sense to me to use the code based on diagnosis even if both fractures do not get fixated with hardware. Lately we have been getting denials, mostly from UHC, saying that there is a more appropriate CPT code for some of our cases.
For example: Patient has a bimalleolar ankle fracture consisting of the lateral malleolus and the medial malleolus. The lateral malleolus is fixated, but the medial is not. This is still a bimalleolar ankle fracture. There was open reduction and internal fixation. So we coded with the 27814. The carrier is denying the 27814 saying there is a more appropriate CPT code.
I have talked to other coders and an auditor who agrees that this is coded correctly and that I am right to code these based on diagnosis. I was hoping to get other opinions and/or suggestions and see if anyone else has been having the same issues. Any comments are appreciated.
Thank you!
For example: Patient has a bimalleolar ankle fracture consisting of the lateral malleolus and the medial malleolus. The lateral malleolus is fixated, but the medial is not. This is still a bimalleolar ankle fracture. There was open reduction and internal fixation. So we coded with the 27814. The carrier is denying the 27814 saying there is a more appropriate CPT code.
I have talked to other coders and an auditor who agrees that this is coded correctly and that I am right to code these based on diagnosis. I was hoping to get other opinions and/or suggestions and see if anyone else has been having the same issues. Any comments are appreciated.
Thank you!