Orthopedic Coding Alert

Question: Which CPT and ICD-9 codes should we report when the surgeon dictates a Weber B fracture repair?

Oklahoma Subscriber

Answer: Depending on whether the surgeon performed an open or closed repair, you should select a code from the following range for a Weber B fracture:

• 27786 -- Closed treatment of distal fibular fracture (lateral malleolus); without manipulation

• 27788 -- ... with manipulation

• 27792 -- Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when performed.

Orthopedic surgeons often use terms in their dictation that don't appear in CPT, and "Weber B" is one of those. When a surgeon addresses a Weber B fracture, he is usually treating a fracture in the distal fibula, which is coded as a lateral malleolar fracture (824.2-824.3).

The Weber classification describes only the level of the distal fibular fracture, which could also be part of a bimalleor or trimalleolar fracture pattern (although rare), or a lateral malleolar fracture. Type A describes the distal fibular fracture below the ankle syndesmosis. Type B has the distal fibular fracture intersecting the syndesmosis, and Type C involves the distal fibular fracture above the syndesmosis. Patients may have a concomitant medial malleolar fracture, which, if treated, would be coded as a bimalleolar ankle fracture.

-- Reader Questions and You Be the Coder were reviewed by Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network LLC; and Bill Mallon, MD, orthopedic surgeon and medical director at Triangle Orthopaedic Associates in Durham, N.C.