Summary & Overview
CPT 27769: Open Repair of Posterior Malleolus Fracture with Fixation
CPT code 27769 denotes an open reduction and internal fixation procedure for posterior malleolus fractures, involving placement of screws and plates as needed to maintain alignment and relieve pain during healing. This operative orthopedic code is nationally relevant because ankle and distal tibia fractures comprise a meaningful portion of trauma and elective orthopedics caseloads; accurate coding affects clinical documentation, surgical quality measurement, and payment integrity. Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and the operational considerations that drive coding and billing for open fixation of posterior malleolus fractures. The publication summarizes standard procedural intent, common care settings, and what to expect in payer coverage discussions without prescribing clinical decisions. Where available, benchmarking and policy implications relevant to national payer practices are outlined; where input data is missing, the report notes that information was not provided. This resource is intended for coding professionals, practice managers, and clinicians who need a clear, national-level briefing on CPT code 27769.
Billing Code Overview
CPT code 27769 describes an open surgical repair of a posterior malleolus fracture with placement of screws and plates as needed. The procedure is performed to restore and maintain fracture alignment, prevent displacement during healing, and relieve pain.
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Service type: Open fracture fixation (operative orthopedic procedure)
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Typical site of service: Hospital operating room or ambulatory surgical center where orthopedic open reduction and internal fixation procedures are performed.
Clinical & Coding Specifications
Clinical Context
A 46-year-old male presents to the emergency department after a fall from a ladder with acute right ankle pain, swelling, and inability to bear weight. Imaging (AP, lateral, and mortise ankle radiographs and CT for preoperative planning) demonstrates a displaced posterior malleolus fracture of the distal tibia involving the articular surface. The orthopedic trauma surgeon schedules an open reduction and internal fixation (ORIF) of the posterior malleolus under general anesthesia. In the operating room, the surgeon makes a posterior incision, exposes the fracture, achieves anatomic reduction, and stabilizes the fragment with lag screws and a low-profile plate as indicated to restore joint congruity and prevent displacement during healing. The procedure is billed using 27769 for repair of the posterior malleolus with screws and plates as necessary. Typical postoperative care includes perioperative analgesia, immobilization in a splint or cast, radiographic confirmation of alignment, and follow-up outpatient visits for wound check and progressive weight-bearing guidance. Typical site of service is an inpatient or outpatient hospital operating room; ambulatory surgery centers may be used when patient comorbidities and facility resources permit.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral procedure | When both ankles undergo separate posterior malleolus repairs during the same operative session |