Summary & Overview
CPT 27823: Trimalleolar Ankle Fixation (ORIF)
Headline: CPT code 27823 covers surgical fixation of trimalleolar ankle fractures — a definitive procedure for unstable ankle fractures that involve the medial, lateral, and posterior malleoli.
Lead: CPT code 27823 designates open surgical fixation of all three malleoli of the ankle with plates, screws, wires, or pins. The code is nationally relevant because trimalleolar fractures are high-acuity injuries often requiring operative management, inpatient or ambulatory surgery resources, and substantial postoperative care.
Why it matters: This code captures a complex orthopedic reconstructive procedure with implications for hospital resource use, surgical quality measurement, and payer coverage policies. Appropriate coding affects facility and professional billing, utilization review, and comparative benchmarking across national payers.
Key payers covered: Analysis commonly includes Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: The publication provides clinical context for CPT code 27823, typical sites of service, common billing modifiers and coding considerations (listed elsewhere), and payer-specific coverage patterns where available. It also summarizes benchmarks relevant to utilization and resource intensity and highlights policy updates that may affect coverage and prior authorization practices.
Data availability: Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line details.
Billing Code Overview
CPT code 27823 describes surgical fixation of all three malleoli of the ankle — the medial, lateral, and posterior malleoli — using plates, screws, wires, or pins. The procedure typically addresses unstable trimalleolar fractures that require internal fixation to restore joint alignment and stability.
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Service type: Surgical orthopedic procedure — open reduction and internal fixation (ORIF) of the ankle involving fixation of the medial, lateral, and posterior malleoli
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Typical site of service: Hospital inpatient or ambulatory surgery center, depending on fracture severity and patient comorbidity
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45-year-old adult who presents to the emergency department after a high-energy ankle injury (for example, a fall from height or motor vehicle collision) with severe ankle pain, deformity, swelling, and inability to bear weight. Radiographs and CT confirm a trimalleolar fracture with displacement and joint instability involving the medial malleolus, lateral malleolus, and posterior malleolus. The orthopedic trauma or foot and ankle surgeon evaluates the patient, documents mechanism of injury, neurovascular status, comorbidities, and preoperative consent. Initial management includes immobilization, analgesia, tetanus update as needed, and reduction if urgent. The patient is scheduled for operative open reduction and internal fixation using plates, screws, wires, or pins to secure the medial and lateral malleoli and fixation of the posterior malleolus. Typical site of service is an acute care hospital operating room; ambulatory surgery center may be used if patient condition permits. Postoperative care includes immobilization or splinting, DVT prophylaxis as indicated, wound checks, and staged radiographs. Rehabilitation with protected weight-bearing follows fracture healing and surgeon protocol.
Coding Specifications
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The most applicable service type is Surgical: Open reduction and internal fixation (ORIF) of a trimalleolar ankle fracture.
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Typical site of service is Hospital outpatient or inpatient operating room; ambulatory surgery center when medically appropriate.
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