Orthopedic Coding Alert

" Pilon fractures sometimes involve the fibula

If you think you can't bill external fixation codes along with pilon fracture treatment, you've fallen prey to one of the many myths surrounding pilon fracture coding. Follow our coding advice to put your pilon fracture coding on the right track. Anatomical Terminology Is Key First step: Before you can select the appropriate code for a pilon fracture, you should know what type of injury these fractures describe. A pilon" or tibial plafond fracture is an intra-articular fracture of the distal tibia " says Kenneth Swal MD an orthopedic surgeon in Dallas. "These injuries are usually caused by a trauma to the ankle that can also damage the soft tissues so these fractures can be very difficult to treat."

Three CPT codes describe pilon fracture treatments:
  27826 - Open treatment of fracture of weight-bearing articular surface/portion of distal tibia (e.g. pilon or tibial plafond) with internal or external fixation; of fibula only

27827 - ... of tibia only

27828 - ... of both tibia and fibula. Some coders might do a double take when reading the above code descriptors because two of the three codes mention fibula fixation even though pilon fractures occur in the distal tibia. But don't flip to a different section of CPT just yet. Pilon Fractures Can Include the Fibula Pilon fractures may or may not include an associated fibula fracture noncomitant to the injury says Paul K. Kosmatka MD orthopedic surgeon at the Marshfield Clinic. That's why these three codes are grouped the way they are - to address one particular injury complex and its various treatments. "The fibula fracture doesn't necessarily constitute a 'separate' injury but rather is part and parcel of the 'pilon' or 'plafond' fracture "

Kosmatka says.

Tip: "One selects the appropriate code based on which portions of the injury receive fixation not based on which bone is broken " Kosmatka says.

Therefore if the patient has tibia and fibula fractures but the physician only performs fixation on the tibia you should report 27827.

In such a case "the tibial fixation indirectly stabilizes the fibula " Kosmatka says. "Thus one could argue that the fibula has been 'fixed ' but not by any direct instrumentation. In this case I think it is not appropriate to code 27828." Instead you should simply report code 27827 only. Report External Fixation Separately Because your surgeon will probably repair the fracture with plates and screws don't forget to bill separately for the external fixation when warranted.

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