Summary & Overview
CPT 27818: Closed Trimalleolar Ankle Fracture, Non‑operative Treatment
CPT code 27818 represents the closed, non‑operative treatment of a trimalleolar ankle fracture involving the medial, lateral, and posterior malleoli. This code captures management that realigns and immobilizes all three malleoli without open surgery and is relevant across emergency, outpatient, and ambulatory surgical settings. Nationally, accurate reporting of this code affects claims processing, clinical quality measurement, and aggregate utilization of non‑operative orthopedic fracture care.
Key payers covered 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, common modifiers associated with orthopedic procedure reporting, and national benchmarking considerations. The publication outlines what to expect from payer coverage patterns and documentation priorities tied to closed reduction and immobilization of complex ankle fractures.
This summary equips clinicians, billers, and policy professionals with the core facts about CPT code 27818, how it is used in clinical practice, and the areas where coding, documentation, and payer policy intersect. Data not available in the input is noted where applicable in detailed sections.
Billing Code Overview
CPT code 27818 describes closed treatment of a trimalleolar ankle fracture (medial, lateral, and posterior malleoli) using non‑operative realignment and immobilization techniques. The procedure focuses on restoring anatomic alignment of all three malleoli without open surgical exposure.
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Service type: Closed fracture management / fracture reduction and immobilization
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Typical site of service: Hospital outpatient department, emergency department, or ambulatory surgery center where orthopedic closed reduction and casting or splinting can be performed
Clinical & Coding Specifications
Clinical Context
A 42-year-old male presents to the emergency department after a fall from a ladder and immediate inability to bear weight on the right ankle. Physical exam demonstrates swelling, deformity about the ankle, and point tenderness over the medial, lateral, and posterior malleoli. Plain radiographs confirm a closed trimalleolar ankle fracture without open wound. The orthopedic team performs a closed reduction of the ankle in the ED under conscious sedation to restore alignment, relieve pain, and allow safe temporary immobilization and neurovascular re-evaluation prior to definitive fixation planning.
Clinical workflow:
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Initial triage with vital signs and neurovascular exam.
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Analgesia and conscious sedation in the ED.
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Closed reduction maneuver performed by an orthopedic surgeon or emergency physician with orthopedic privileges.
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Post-reduction radiographs to confirm alignment.
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Immobilization in a splint or cast and documentation of neurovascular status post-procedure.
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Disposition planning: admission for operative fixation or outpatient orthopedic follow-up depending on stability and associated injuries.
Coding Specifications
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