Bimalleolar vs trimalleolar ORIF Code

[JOB7965]

Not sure what to code. Patient has a trimalleolar ankle fracture but the doctor only fixes the medial and lateral malleoli. Do I still code 27822 or does it revert to a bimalleolar ORIF with a trimalleolar dx? Help!

 

[abbycat333]

Bimalleolar vs trimalleolar codes

If three malleoli are fractured, you should use a trimalleolar fracture code, even if only two are fixed. For example, if the posterior malleolus is non displaced, and is not fixed, you would use 27822. Do not switch the CPT to bimalleolar ORIF, since the amount of work involved in ORIF bimalleolar is different than in a trimalleolar, even if the posterior is not fixed.

 

[deannasherland]

if the doctor fixes the bimalleolar ankle fractures but the dx is tri - you use the code for the work that was done 27814 with dx tri -
this is done quite often with trimalleolar fractures where the doctor only fixes two.

 

[emmyjean]

I agree with abbycat. If the diagnosis is trimalleolar fx, the CPT will follow as a tri mall fx without fixation of the posterior lip. Having a diagnosis code for trimalleolar, but CPT for bimalleolar may possibly be denied by the insurance company.

 

[amyjph]

I agree with abbycat as well. If the diagnosis is trimalleolar fracture you use the ORIF trimalleolar CPT codes.