CPT 27814 ORIF Two Malleoli — Reimbursement

CPT code 27814 represents open reduction and internal fixation (ORIF) of two malleoli of the ankle — commonly used for bimalleolar or bimalleolar-equivalent unstable fractures that require plates, screws, wires, or pins for stabilization. Nationally, this code is significant because ankle fractures are common injuries that often require operative management, drive surgical resource use in operating rooms and ambulatory surgical centers, and interact with payer policies on surgical coverage and outpatient surgery site eligibility.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines clinical context for CPT code 27814, site-of-service implications, typical utilization patterns, and the administrative components that affect billing and reimbursement across major payers.

Readers will learn: the clinical intent and typical care setting for the procedure; common procedural elements that influence coding and billing; payer coverage considerations and where policy variations commonly arise; and benchmark-oriented content such as expected settings of care and procedural drivers of cost. Data not available in the input is noted where payer-specific policy details or diagnosis mappings would normally appear.

Billing Code Overview

CPT code 27814 describes a surgical procedure for fixation of two malleoli of the ankle — combinations include the lateral and medial malleoli, the lateral and posterior malleoli, or the medial and posterior malleoli. The provider secures the malleoli with a plate and screws, wires, or pins to stabilize an unstable fracture that requires internal fixation for additional support.

Service type: Orthopedic surgical fixation of ankle fractures (open reduction and internal fixation of bimalleolar or bimalleolar-equivalent fractures)
Typical site of service: Hospital operating room or ambulatory surgical center for operative fracture fixation

Clinical Context

A 42-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 demonstrate an unstable bimalleolar ankle fracture involving the lateral and medial malleoli with displacement and talar instability. After preoperative evaluation and informed consent, the patient is taken to the operating room for open reduction and internal fixation. Under general anesthesia in a sterile operating room environment, the orthopedic surgeon exposes the fractured malleoli, reduces the fragments anatomically, and secures them with a combination of a plate and screws for the lateral malleolus and screws or tension band wiring for the medial malleolus. Perioperative fluoroscopy confirms reduction and hardware placement. The patient is recovered in the PACU and discharged with immobilization, non-weight-bearing instructions, analgesics, and a planned follow-up within 10–14 days for wound check and suture removal, with progressive weight-bearing guided by radiographic healing.

Coding Specifications

Modifier	Description	When to Use
`RT`	Right side	Use when the procedure is performed on the right lower extremity.
`LT`	Left side

Taxonomy Code	Specialty	Notes
207L00000X	Orthopaedic Surgery	Primary specialty performing operative ankle fracture fixation.
207LA0000X	Hand Surgery (Orthopedic subspecialty)	Orthopedic subspecialists may perform complex lower extremity fixation; included for completeness of common orthopedics taxonomies.
208600000X	General Surgery	General surgeons occasionally perform lower extremity trauma surgery in resource-limited settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S82.241A`	Displaced bimalleolar fracture of right lower leg, initial encounter for closed fracture	Typical indication for open reduction and internal fixation of medial and lateral malleoli.
`S82.242A`	Displaced bimalleolar fracture of left lower leg, initial encounter for closed fracture	Left-sided counterpart indicating surgery on the left ankle.
`S82.251A`	Displaced trimalleolar fracture of right lower leg, initial encounter for closed fracture	When posterior malleolus is involved in addition to medial and lateral malleoli; may change surgical approach or coding to trimalleolar codes.
`S82.201A`	Displaced malleolar fracture, unspecified ankle, right, initial encounter for closed fracture	Used when documentation specifies displaced malleolar fractures requiring fixation but exact malleoli not fully detailed.
`S82.202A`	Displaced malleolar fracture, unspecified ankle, left, initial encounter for closed fracture	Left-sided unspecified malleolar fracture for initial encounters.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27766`	Open treatment of bimalleolar ankle fracture, with or without internal or external fixation, when performed for fractures involving talar dome or posterior malleolus	Alternative open fixation code used for certain bimalleolar patterns; may be considered when posterior malleolus is a primary focus.
`27822`	Open treatment of trimalleolar ankle fracture, with internal fixation	Performed when the posterior malleolus plus medial and lateral malleoli are fixed; may be used if a third malleolus is addressed.
`20680`	Removal of deep implant; complicated (e.g., plate, screw)	May be performed at a later date if hardware removal is indicated for pain, infection, or intolerance.
`20550`	Injection; single tendon sheath, ligament, or ganglion cyst	Used postoperatively in different contexts for diagnostic or therapeutic injections for residual pain (ancillary in some workflows).
`99024`	Postoperative follow-up visit, normally included in the global period (for reporting additional unrelated visits)	Documentation of global period visit reporting when payer rules require separate reporting for unrelated services.

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Summary & Overview

CPT 27814: Open Reduction and Internal Fixation of Two Malleoli