Orthopedic Coding Alert

Question: A patient is placed on the operating table in the supine position. After adequate general anesthesia, a closed reduction was carried out to a displaced fracture of the right distal tibial epipysis. This was a Salter Type II. The fracture was reduced with some difficulty, by applying traction. The image intensifier at that time showed excellent reduction of the fracture, and good position of the ankle. The patient was then placed in a short leg cast, and repeat x-rays showed good position of the fracture and the ankle. How should we code for this?

Thomas Little
Jeff Anderson Regional Medical Center, MS

Answer: The correct code for this situation is 27825 (closed treatment of fracture of weight bearing articular portion of distal tibia [e.g., pilon or tibial plafond] with or without anesthesia; with skeletal traction and/or requiring manipulation). Even though the code suggests pilon or tibial plafond fractures as types to be repaired, those are not the only types of fractures to which this code applies. A Salter fracture would also apply if, as described in the question, it occurred in the distal tibial epiphysis, or per Dorlands dictionary, the expanded articular end of the distal tibing.