Orthopedic Coding Alert

Here’s the 2 or 3 tips you need to master these fracture codes.

When a patient reports with an ankle fracture, there are several considerations the coder must take into account. One of the most important is whether the patient suffered a bimalleolar or trimalleolar ankle fracture.

Help’s here: To get the 411 on these fracture types, we asked Lynn M. Anderanin, CPC, CPMA,CPPM, CPC-I, COSC, senior director of coding education at Healthcare Information Services in Park Ridge, Illinois.

Here’s what she had to say.

Bimalleolar = 2 Bones

The defining characteristic of a bimalleolar ankle fracture is actually quite simple. A bimalleolar ankle fracture will involve two bones:

typically, the medial, distal, end of the tibia, or medial malleolus; and the distal, outside, end of the fibula, or lateral malleolus. The break could also involve the posterior malleolus.

You’ll report these fracture fixes with the following codes:

• 27808 (Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); without manipulation)
• 27810 (… with manipulation)
• 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)

Treatment course: When a patient suffers a bimalleolar ankle fracture, they have often “injured their ankle by rolling or twisting the ankle, causing fractures in these bones. An X-ray will confirm the fracture, and depending on the severity and displacement, it will be treated with manipulation and/or open treatment,” explains Anderanin.

Trimalleolar = 3 Bones

The defining characteristic of a trimalleolar ankle fracture is simple as well. “A trimalleolar fracture is a bimalleolar fracture with the addition of a fracture to the posterior portion of the tibia, for a total of three fractured bones.

This bone is sometimes called the posterior malleolus,” says Anderanin.

You’ll report these fracture fixes with the following codes:

• 27816 (Closed treatment of trimalleolar ankle fracture; without manipulation)
• 27818 (… with manipulation)
• 27822 (Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; without fixation of posterior lip)
• 27823 (… with fixation of posterior lip)

Treatment course: While a trimalleolar fracture features three broken bones, “there can also be ligament damage in addition of these fractured bones in many cases; again, caused by a twisting or rolling of an ankle,” Anderanin explains. As with a bimalleolar fracture, an X-ray is used to confirm a trimalleolar fracture and it is treated with manipulation and/or open treatment.