If you think you can't bill external fixation codes along with pilon fracture treatment, you've fallen prey to one of the many myths surrounding pilon fracture coding. Follow our coding advice to put your pilon fracture coding on the right track. Anatomical Terminology Is Key First step: Before you can select the appropriate code for a pilon fracture, you should know what type of injury these fractures describe. A pilon" or tibial plafond fracture is an intra-articular fracture of the distal tibia " says Kenneth Swal MD an orthopedic surgeon in Dallas. "These injuries are usually caused by a trauma to the ankle that can also damage the soft tissues so these fractures can be very difficult to treat."
Three CPT codes describe pilon fracture treatments:
27826 - Open treatment of fracture of weight-bearing articular surface/portion of distal tibia (e.g. pilon or tibial plafond) with internal or external fixation; of fibula only
27827 - ... of tibia only
27828 - ... of both tibia and fibula. Some coders might do a double take when reading the above code descriptors because two of the three codes mention fibula fixation even though pilon fractures occur in the distal tibia. But don't flip to a different section of CPT just yet. Pilon Fractures Can Include the Fibula Pilon fractures may or may not include an associated fibula fracture noncomitant to the injury says Paul K. Kosmatka MD orthopedic surgeon at the Marshfield Clinic. That's why these three codes are grouped the way they are - to address one particular injury complex and its various treatments. "The fibula fracture doesn't necessarily constitute a 'separate' injury but rather is part and parcel of the 'pilon' or 'plafond' fracture "
Tip: "One selects the appropriate code based on which portions of the injury receive fixation not based on which bone is broken " Kosmatka says.
Therefore if the patient has tibia and fibula fractures but the physician only performs fixation on the tibia you should report 27827.
In such a case "the tibial fixation indirectly stabilizes the fibula " Kosmatka says. "Thus one could argue that the fibula has been 'fixed ' but not by any direct instrumentation. In this case I think it is not appropriate to code 27828." Instead you should simply report code 27827 only. Report External Fixation Separately Because your surgeon will probably repair the fracture with plates and screws don't forget to bill separately for the external fixation when warranted.
Orthopedic Coding Alert
Learn how 0054T-0056T can ease your CAD claims
When a patient presents for a follow-up visit [...]
Prosthesis dislocations during global can be payable, if you know how to bill
If your patient's [...]
" Pilon fractures sometimes involve the fibula
If you think you [...]
4 Scenarios Put Your Same-Day Modifier Use to the Test
Multiple procedures or spinal levels may merit modifiers, but not always
When your orthopedic surgeon [...]
Does Gentle Manipulation Merit 25605?
Question: We recently treated a radial fracture (25600). A few days later, the patient returned [...]
Don't Count on Casting Supply Reimbursement
Question: When can we bill for cast supplies? Can we bill "Q" codes with initial [...]
Thermal Shrinkage? Report Unlisted
Question: Our surgeon performed an arthroscopic thermal shrinkage of the ACL. Which code should we [...]
Bundle 99238 Into Surgical Package
Question: Can we report 99238 to reflect the surgeon's work discharging a patient if the [...]
Seek Local Payer Guidance for Intraop Fluoro
Question: Which code should we report if our surgeon interprets intraoperative fluoroscopy? He often uses [...]
Look to 958.4 for Neurogenic Shock Dx
Question: Our trauma surgeon treated a patient who had an injury caused by a motorcycle [...]