Summary & Overview
CPT 27726: Repair of Fibular Nonunion or Malunion with Internal Fixation
CPT code 27726 denotes open surgical repair of a fibular fracture that has failed to heal or has healed in poor alignment, using internal fixation to restore function and relieve pain. Nationally, this orthopedic procedure is clinically significant for patients with persistent disability, deformity, or pain after initial fibular fracture management. It is performed across inpatient and outpatient surgical settings and influences surgical utilization, bundled payment calculations, and postoperative care pathways.
Key payers in the national context include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical indications and typical sites of service, payer coverage patterns, and common billing considerations. The publication also summarizes benchmarking metrics where available, coding and documentation expectations that affect reimbursement, and relevant policy updates impacting authorization and bundle management.
The content presents clinical context for CPT code 27726, outlines payer approaches to coverage and claims adjudication, and highlights operational impacts for surgical practices and facilities. Data gaps in the input are noted where specific benchmarking or diagnosis mappings are not provided. The focus is national and intended for coding professionals, orthopedic providers, revenue cycle staff, and policy analysts.
Billing Code Overview
CPT code 27726 describes the surgical repair of a fibular fracture that has failed to heal (nonunion) or has healed with poor alignment, using internal fixation. The procedure is performed to restore ankle and lower-leg function and to relieve pain associated with malunion or nonunion of the fibula.
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Service type: Surgical orthopedic procedure (open reduction and internal fixation of fibular nonunion or malunion)
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Typical site of service: Hospital inpatient or ambulatory surgical center, depending on patient condition and surgical complexity
Clinical & Coding Specifications
Clinical Context
A 46-year-old recreational runner presents with persistent lateral ankle pain and instability nine months after an initial distal fibular fracture treated conservatively with a cast. Radiographs and CT demonstrate nonunion with malalignment of the distal fibula and ankle mortise incongruity. The orthopedic surgeon schedules open reduction and internal fixation of the fibula with possible bone grafting to restore alignment, improve ankle stability, and relieve pain. The clinical workflow includes preoperative evaluation (history, focused physical exam, imaging review), informed consent including risks/benefits, perioperative anesthesia evaluation, the operative procedure 27726 (open treatment of nonunion or malunited fibular fracture with internal fixation), intraoperative fluoroscopy as needed, postoperative immobilization or splinting, pain control, and scheduled follow-up with radiographs to assess healing and range-of-motion rehabilitation with physical therapy as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral procedure | Use when both fibulae are repaired during the same operative session. |
62 |