Summary & Overview
CPT 27822: Fixation of Medial and Lateral Malleoli for Ankle Fracture
CPT code 27822 designates open reduction and internal fixation of ankle fractures in which the medial and lateral malleoli are fixed with hardware while the posterior malleolus receives no fixation. This procedure is performed for unstable bimalleolar or trimalleolar fractures that require surgical stabilization to restore joint congruity and permit healing. Nationally, accurate coding for operative ankle fracture care impacts surgical quality measurement, bundled payment populations, and hospital case mix reporting.
Key payers in typical coverage analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the procedure, typical sites of service (hospital OR or ambulatory surgery center), common billing modifiers used with operative procedures (Data not available in the input beyond the provided list), and where this code fits among related ankle fracture procedures. The publication summarizes benchmarking metrics, common billing considerations, and policy updates relevant to coverage and reimbursement for operative ankle fracture management. It is intended to inform coding professionals, surgical departments, and payers about the clinical scope and billing implications of CPT code 27822 in a national context.
Billing Code Overview
CPT code 27822 describes surgical fixation of bimalleolar or trimalleolar ankle fractures in which the provider fixes the medial and lateral malleoli with plates, screws, wires, or pins but does not apply fixation to the posterior malleolus. This procedure addresses unstable ankle fractures that require internal fixation to restore alignment and stability.
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Service type: Surgical orthopedics — open reduction and internal fixation of ankle fractures
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Typical site of service: Inpatient or outpatient hospital operating room or ambulatory surgery center, depending on fracture severity and patient status
Clinical & Coding Specifications
Clinical Context
A 42-year-old male presents to the emergency department after a fall from a ladder sustaining a trimalleolar fracture of the right ankle. Imaging (plain radiographs and CT) confirms displaced fractures of the medial malleolus, lateral malleolus, and a non-displaced posterior malleolus with ankle joint instability. The orthopedic trauma surgeon schedules operative fixation under general anesthesia. Intraoperative steps include open reduction and internal fixation of the medial and lateral malleoli using plates and screws, and stabilization of the syndesmosis as needed; no fixation is applied to the posterior malleolus per intraoperative decision. Postoperative care includes neurovascular checks, immobilization in a splint or cast, pain management, physical therapy planning, and routine follow-up radiographs to document reduction and hardware position.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the procedure requires substantially greater effort, time, or technical difficulty than typical and documentation supports increased work. |
23 | Unusual anesthesia | Use when a procedure is performed under general anesthesia because local/regional anesthesia is contraindicated and documentation supports unusual anesthesia circumstances. |