Summary & Overview
CPT 27784: Fibula Shaft or Distal Fibula Fracture Fixation
CPT code 27784 denotes open reduction and internal fixation (ORIF) of a fibula shaft or distal fibula fracture, often using plates, screws, wires, or pins to stabilize the bone. This code captures definitive surgical management for displaced or unstable fibular fractures and is a common orthopedic procedure in trauma and sports medicine practice. Nationally, accurate reporting of this code affects surgical case mix, facility and surgeon reimbursement, and quality measurement related to fracture care.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical and billing context for CPT code 27784, including typical sites of service, commonly billed associated modifiers (listed separately), and how this procedure is classified within surgical service lines. The publication outlines benchmarks and policy-relevant guidance on coding consistency, common billing scenarios, and factors that influence claim adjudication for fibular ORIF procedures.
The content provides concise clinical background, coding considerations, and the types of payer policies that commonly apply to orthopedic fracture fixation. Data not available in the input is noted where specific payer policies, associated taxonomies, or ICD-10 pairing guidelines would normally be presented.
Billing Code Overview
CPT code 27784 describes a surgical procedure to fix a fracture of the fibula shaft or distal fibula (end of the fibula). The procedure involves open reduction and internal fixation of the fibula and may include the use of plates, screws, wires, or pins to achieve and maintain fracture stability.
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Service type: Surgical fracture fixation (orthopedic procedure)
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Typical site of service: Hospital operating room or ambulatory surgery center, performed by an orthopedic surgeon or trauma surgeon
Clinical & Coding Specifications
Clinical Context
A 42-year-old male presents to the emergency department after a fall from a ladder with acute right lateral ankle pain, swelling, and inability to bear weight. Radiographs demonstrate a displaced fracture of the distal fibular shaft with slight talar shift. The patient is medically optimized, consented, and taken to the operating room for open reduction and internal fixation of the fibular fracture. The surgical workflow includes preoperative imaging review, regional or general anesthesia, sterile prep and drape of the lower extremity, open reduction of the fibular fracture, fixation using a plate and screws (and additional screws or wires if required), intraoperative fluoroscopic confirmation of reduction and hardware position, wound closure, and application of a sterile dressing and postoperative immobilization (splint or cast). Postoperative care includes pain control, neurovascular checks, anticoagulation assessment, and discharge planning with outpatient orthopedic follow-up for wound check and progressive weight-bearing guidance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard reporting when no specific modifier applies |
22 | Increased procedural services |