Podiatry Coding & Billing Alert

Question: My podiatrist fixed the patient’s fibula on the day of the injury and placed a temporary external fixator to stabilize the tibia. Since the patient had severe swelling of tissue, this external fixator will allow inspection of the soft tissue without frequent splint changes. My podiatrist did not make an incision through the damaged tissue. My podiatrist planned a second procedure for two weeks later. At that time, the patient returned to the operating room (OR), and my podiatrist removed the external fixator and converted to internal fixation after the soft swelling reduced. How should I report this?

Pennsylvania Subscriber

Answer: You should report codes 27826 (Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of fibula only) and 20690 (Application of a uniplane (pins or wires in 1 plane), unilateral, external fixation system) for the first date of service, followed by 27827 (Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of tibia only) for the second date of service.

Mind your modifiers: You should append modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) to code 27827 because your podiatrist performed the initial fixation with the intent of returning to the OR to convert to internal fixation.

Don’t miss: This injury is an example of a pilon fracture, also known as a plafond fracture. A pilon fracture is a fracture of the distal part of the tibia, involving its articular surface at the ankle joint. Pilon fractures are complicated, comminuted fractures that have a poor long-term outcome. Pilon fractures are usually caused by rotational or axial forces, usually a result of falls from a height or car accidents.