CPT 27792 ORIF Distal Fibula — Reimbursement | OpenPayer

Summary & Overview

CPT 27792: ORIF of Distal Fibula Fracture

CPT code 27792 denotes open reduction and internal fixation (ORIF) of a distal fibula fracture, including stabilization with plates, screws, wires, or pins. This code captures definitive surgical management for ankle-region fibular fractures and is commonly used in orthopaedic trauma and foot & ankle practices. Nationally, accurate use of this code affects hospital and ambulatory surgery center billing, quality measurement for fracture care, and aggregated procedure volume tracking across payers. Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find a concise clinical and billing overview, typical sites of service, common modifiers and payers, and context for how the code fits into orthopaedic surgical services. The publication highlights benchmarking elements such as utilization patterns, payer coverage considerations, and policy updates relevant to surgical fracture fixation reimbursement and coding compliance. Clinical context covers indications for ORIF of distal fibula fractures and expected procedural components. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare27792CPTorthopaedicsdistal-fibulaopen-reduction-internal-fixationankle-fracturesurgical-procedureambulatory-surgeryhospital-OR

Billing Code Overview

CPT code 27792 describes surgical treatment of a distal fibula fracture, including internal fixation using plates and screws, wires, or pins. This procedure addresses a break in the lower end of the fibula bone of the leg and involves open reduction and internal fixation to restore alignment and stability.

Service type: Surgical orthopaedic procedure (open reduction and internal fixation of distal fibula fracture)
Typical site of service: Hospital operating room or ambulatory surgical center

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. Radiographs and CT confirm a displaced distal fibular fracture with mild ankle instability. The orthopedic surgeon plans open reduction and internal fixation (ORIF) of the distal fibula to restore length, alignment, and ankle stability using a plate and screws. Preoperative evaluation includes medical clearance, informed consent, and routine labs. The patient is taken to the ambulatory surgery center (or hospital operating room for higher-risk patients). Under regional or general anesthesia, the surgeon performs 27792 (ORIF, distal fibula, with plate/screws/wires/pins), achieves anatomic reduction, and secures fixation. Postoperative workflow includes recovery room monitoring, pain control, neurovascular checks, immobilization in a splint or boot, discharge instructions with non–weight-bearing precautions, and scheduled follow-up with radiographs to verify healing and hardware position. Typical site of service is the hospital operating room or ambulatory surgery center. Service type is surgical orthopedic procedure for fracture fixation.

Coding Specifications

Modifier	Description	When to Use
`50`	Bilateral procedure	Use when `27792` is performed on both lower extremities during the same operative session.

CPT 27827: Open Reduction, Internal Fixation of Distal Tibia Fracture

CPT-27759-TIBIAL-SHAFT-INTRAMEDULLARY-NAILING

CPT 27759: Tibial Shaft Intramedullary Nailing

CPT-27818-CLOSED-TRIMALLEOLAR-ANKLE-FRACTURE-CLOSED-TREATMENT

CPT 27818: Closed Trimalleolar Ankle Fracture, Non‑operative Treatment

CPT-27842-CLOSED-TREATMENT-ANKLE-DISLOCATION-ANESTHESIA

CPT 27842: Closed Treatment of Ankle Dislocation with Anesthesia

CPT-27831-PROXIMAL-TIBIOFIBULAR-JOINT-CLOSED-REDUCTION-ANESTHESIA

CPT 27831: Closed Reduction of Proximal Tibiofibular Joint Dislocation

CPT-27750-CLOSED-TREATMENT-TIBIAL-SHAFT-FRACTURE-IMMOBILIZATION

CPT 27750: Closed Treatment of Tibial Shaft Fracture

CPT-27848-SURGICAL-OPEN-TREATMENT-ANKLE-DISLOCATION

CPT 27848: Open Surgical Treatment of Ankle Dislocation

CPT-27780-LONG-LEG-CAST-PROXIMAL-FIBULA-SHAFT-FIBULA-FRACTURE

CPT 27780: Long Leg Cast for Proximal or Shaft Fibula Fracture

CPT-27786-DISTAL-FIBULA-FRACTURE-NONMANIPULATIVE-TREATMENT

CPT 27786: Nonmanipulative Treatment of Distal Fibula Fracture

CPT-27826-DISTAL-TIBIA-FIBULAR-FIXATION-OPEN-REDUCTION-INTERNAL-FIXATION

CPT 27826: Open Fixation of Distal Tibia with Fibular Stabilization

Showing 1–10 of 36

Taxonomy Code	Specialty	Notes
`207X00000X`	Orthopaedic Surgery	Primary specialty performing ORIF of distal fibula.
`2080P0222X`	Podiatry (Foot and Ankle Surgery)	Podiatric surgeons may perform fibular ORIF when within scope of practice.
`2086S0122X`	Orthopaedic Surgery of the Lower Extremity	Subspecialty focusing on ankle and foot trauma.
`2084P0800X`	General Surgery	In limited or resource-constrained settings may assist or perform fracture fixation.
`174400000X`	Emergency Medicine	Involved in initial reduction, stabilization, and transfer prior to operative fixation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S82.611A`	Displaced fracture of lateral malleolus (fibula), right leg, initial encounter for closed fracture	Direct indication for `27792` when ORIF is required to stabilize a displaced distal fibular fracture.
`S82.612A`	Displaced fracture of lateral malleolus (fibula), left leg, initial encounter for closed fracture	Same as above for left-sided injuries requiring ORIF.
`S82.621A`	Undisplaced fracture of lateral malleolus (fibula), right leg, initial encounter for closed fracture	May be managed nonoperatively, but included as related diagnostic consideration.
`S82.622A`	Undisplaced fracture of lateral malleolus (fibula), left leg, initial encounter for closed fracture	See prior row.
`S82.611B`*	Displaced fracture of lateral malleolus, right leg, subsequent encounter	Relevant for follow-up visits and postoperative care coding during healing.
`S82.691A`	Fracture of the lower end of fibula, open, initial encounter	Open fractures may alter surgical approach and postoperative management for `27792`.
`S82.621D`	Undisplaced fracture of lateral malleolus, right leg, subsequent encounter	Used for routine subsequent visit coding during recovery.

*Suffix letters (A, D, S) denote encounter and healing status; coders must select the appropriate 7th character per ICD-10-CM guidance.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`20690`	Application of external fixation device (separate procedure)	May be used if temporary external stabilization is required before or after `27792` in complex or open fractures.
`28820`	Closed treatment of distal fibular fracture; with manipulation	Used when closed management is performed instead of ORIF; represents a nonoperative alternative to `27792`.
`73560`	Radiologic examination, ankle; 3 views	Common preoperative and postoperative imaging study to document fracture and healing related to `27792`.
`73610`	Radiologic examination, tibia and fibula, single view	Used in initial imaging to evaluate associated tibial involvement with a distal fibular fracture.
`22851`	Application of intervertebral biomechanical device — not applicable; included only if present	Not applicable to ankle; excluded if strict rules prohibit unrelated codes.
`69990`	Regional or general anesthesia monitoring (unlisted)	Anesthesia services are provided during `27792`; anesthesia coding typically uses CPT anesthesia codes `01630`–`01637` depending on approach.

Note: If a code appears less applicable to ankle surgery, it is included only to indicate related perioperative services. Use clinically appropriate anesthesia CPT codes for actual billing of anesthesia services.

OpenPayer