Podiatry Coding & Billing Alert

Keep an eye out in the documentation for "bimalleolar equivalent fracture."

Reporting fractures has a tendency to be confusing and tedious, no matter your specialty. When it comes to coding for ankle fractures, your job becomes even more complicated because many of your fracture care procedure options require you to choose between closed and open treatments.

Read on to learn more about ankle fractures and keep your claims in tip-top shape.

Editor's note: Stay tuned next month for even more FAQs about ankle fractures.

FAQ 1: What CPT^® Code Should I Report for Lateral Malleolus Fractures?

Answer: When a patient has a lateral malleolus fracture, he has a fracture at the end of his fibula. You should report the following codes for lateral malleolus fracture treatment:

• For closed treatment, report either 27786 (Closed treatment of distal fibular fracture (lateral malleolus); without manipulation) or 27788 (... with manipulation). Report 27786 for an application of a cast, CAM walker, splint, or orthosis. Report 27788 when the fracture is displaced and the podiatrist needs to reduce it.
• For open treatment, report 27792 (Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when performed).

FAQ 2: What is the Weber Ankle Fracture Classification?

Answer: Understanding the Weber ankle fracture classifications is vital when reporting ankle fractures, says Angela K. Mondragon, CPC, certified professional coder at Oklahoma Sports and Orthopedics Institute in Norman, Oklahoma. This classification system is used » » for lateral malleolar fractures, relating to the level of the fracture in relation to the ankle joint.

The types of the Weber classification are as follows, according to Mondragon:

• Type A: This type of fracture is located below the tibiotalar joint - below the level of talar dome. It is usually transverse. The tibiofibular syndesmosis is intact, the medial malleolus is occasionally fractured, and it's usually stable if the medial malleolus intact.
• Type B: This type of fracture is located at the level of the tibiotalar joint - the distal extent at the level of the talar dome. It may extend some proximally, and it's usually spiral. The tibiofibular syndesmosis is usually intact, but a widening of the distal tibofibular joint indicates syndesmotic injury. And, the medial malleolus may be fractured.​

            ○ Type B1 - This is an isolated fracture.
            ○ Type B2 - This fracture is associated with a medial lesion (malleolus or ligament).
            ○ Type B3 – This fracture is associated with both a medial lesion and a fracture of the posterolateral tibia.

• Type C: This fracture is located above the tibiotalar joint and syndesmotic ligament compromise - above the level of the ankle joint. It includes tibiofibular syndesmosis disruption with the widening of distal tibiofibular articulation.

"Classification systems can be challenging, but once you understand and memorize them, it helps to communicate to patients and doctors the severity of the injury," says Jordan Meyers, DPM, partner at Raleigh Foot and Ankle Center and consultant at Treace Medical Concepts, Inc. in Raleigh, North Carolina.

FAQ 3: What CPT^® Code Should I Report for Bimalleolar Fractures?

Answer: A bimalleolar fracture involves both the tibia (medial malleolus) and the fibula (lateral malleolus). Report the following codes for bimalleolar fracture treatment:

• For closed treatment, report 27808 (Closed treatment of bimalleolar ankle fracture (e.g., lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); without manipulation) or 27810 (...  with manipulation).
• For open treatment, report 27814 (Open treatment of bimalleolar ankle fracture, (e.g., lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli), includes internal fixation, when performed).

Don't miss: "You do not have to use hardware on both sides of a bimalleolar fracture to bill for bimalleolus fracture repair," according to Mondragon.

If you use hardware on one side, but the other side is stable and does not need hardware, it is still a bimalleous fracture repair, Mondragon says. The fracture is of two parts of the malleolus - lateral and medial; lateral and posterior; or medial and posterior.

"The CPT^® code is written, 'includes internal fixation when performed,' so the fixation does not have to occur on both sides of the malleolus," Mondragon adds.

FAQ 4: What is a Bimalleolar Equivalent Fracture?

Answer: You may see the terms "bimalleolar equivalent fracture" in the documentation. With a bimalleolar equivalent fracture, instead of breaking both the tibia and fibula, the patient has broken his fibula and ruptured his deltoid ligament, according to Meyers.

Problem: CPT® Assistant Vol. 19, No. 3, gives an excellent example to help you remember how to report a bimalleolar equivalent fracture: The patient has a left ankle fracture dislocation with a fractured lateral malleolus, a syndesmosis disruption, and a complete tear of her deltoid ligament. The podiatrist performed an open reduction and internal fixation (ORIF) for the lateral malleolus fracture, an open repair of the deltoid ligament, and repaired the syndesmosis of the distal fibular tibial articulation.

Solution: According to CPT^® Assistant, you would report 27792 "for the lateral malleolus fracture that includes the syndesmosis repair if a screw is put through the plate into the tibia." For the deltoid ligament repair, you would report 27695 (Repair, primary, disrupted ligament, ankle; collateral), appending modifier 51 (Multiple procedures).

On the other hand, if the podiatrist made a separate incision for the syndesmosis repair, you should report 27829 (Open treatment of distal tibiofibular joint (syndesmosis) disruption, includes internal fixation, when performed), along with 27792, per CPT^® Assistant. In this case 27829 is subject to modifier 51.