Orthopedic Coding Alert

Question: A new patient presents to the office suffering from an injured left ankle she hurt while shoveling snow. The orthopedist performs a detailed history and examination. Suspecting a fracture, the orthopedist orders a twoview ankle x-ray, which reveals a bimalleolar fracture. The nonphysician practitioner (NPP) provides local anesthesia, and the surgeon uses closed treatment to manipulate the fracture. To ensure proper alignment, the orthopedist orders a second two-view ankle x-ray. Notes indicate moderate medical decision making. The orthopedist writes the appropriate prescriptions, the NPP casts the ankle and the patient goes home. Can I code both ankle x-rays in this scenario?

Answer: Since the orthopedist orders separate x-rays for different purposes (identifying the fracture, ensuring proper bone placement), you can code for both. On the claim, report the following:

• 27810 (Closed treatment of bimalleolar ankle fracture [e.g., lateral and medial malleoli; or lateral and posterior malleoli or medial and posterior malleoli]; with manipulation) for the fracture care
• 73600 (Radiologic examination, ankle; 2 views) x 2 for the x-rays (one before the surgery, and one to ensure proper bone placement postsurgery)
• 824.4 (Fracture of ankle; bimalleolar, closed) appended to 27810, 99204 and 73600 to represent the patient's ankle fracture
• E016.0 (Activities involving property and land maintenance, building and construction; digging, shoveling and raking) appended to 27810, 99204 and 73600 to represent the cause of the patient's ankle fracture.

Modifier alert: Be sure to check with your payer before filing this claim. Some payers might want you to place a modifier, such as 51 (Multiple procedures) or 59 (Distinct procedural service), to the second x-ray code.