Orthopedic Coding Alert

Question: A patient presented to the Emergency Room and the surgeon performed closed reduction and manipulation for a trimalleolar ankle fracture. The closed reduction didn't work so he returned to surgery to repair the fracture the next day. How should I code both surgeries?

Montana Subscriber

Answer: You'll need to code for three services: the initial visit and examination, the first surgery, and the second surgery.

If the patient was treated in the Emergency Room,choose from 99283-99285 (Emergency department visit for the evaluation and management of a patient ...). If the patient was admitted to the hospital before the decision for surgery was made, report 99222 (Initial hospital care, per day, for the evaluation and management of a patient ...) instead. Append modifier 57 (Decision for surgery) to the correct E/M code.

For the original ankle repair, submit 27818 (Closed treatment of trimalleolar ankle fracture; with manipulation). Include modifier LT (Left side) or RT (Right side) as appropriate.

Submit 27822 or 27823 (Open treatment of trimalleolar ankle fracture, includes internal fixation when performed, medial and/or lateral malleolus; without fixation of posterior lip or with fixation of posterior lip) for the second surgery. Again, include either modifier LT or RT. Also append modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) because the return procedure was more extensive than the original surgery.