How To Use CPT Code 27784

CPT 27784 describes the open treatment of a proximal fibula or shaft fracture, including internal fixation, when performed. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 27784?

CPT 27784 can be used to describe the surgical treatment of a fracture in the shaft or end of the fibula bone. The procedure involves fixing the broken bone using internal fixation methods, such as plates, screws, wires, or pins, when necessary. This code is used when the provider surgically fixes the fracture and secures it with internal fixation devices.

2. Official Description

The official description of CPT code 27784 is: ‘Open treatment of proximal fibula or shaft fracture, includes internal fixation, when performed.’

3. Procedure

1. The provider prepares the patient for surgery and administers anesthesia.
2. An incision is made over the fracture site on the fibula.
3. The provider carefully dissects the tissue down to the bone.
4. The fracture site is identified and explored, and any damaged or devitalized tissue is removed.
5. The provider aligns the fracture fragments in their correct anatomical position.
6. The fracture is fixed using internal fixation devices, such as plates, screws, wires, or pins.
7. Hemostasis is achieved to stop any bleeding.
8. The area is irrigated to clean it.
9. The incision is closed, and a long leg cast, brace, or splint may be applied.
10. Post-treatment X-rays may be taken to ensure the correct alignment of the leg bone.

4. Qualifying circumstances

CPT 27784 is used for patients who have a fracture in the proximal fibula or shaft that requires surgical treatment with internal fixation. The procedure is performed by a provider who is qualified to perform open treatment of fractures. The use of internal fixation devices is necessary to stabilize the fracture and promote proper healing.

5. When to use CPT code 27784

CPT code 27784 should be used when a provider performs open treatment of a proximal fibula or shaft fracture and includes internal fixation as part of the procedure. This code should not be used if external fixation is the primary method of fracture fixation.

6. Documentation requirements

To support a claim for CPT 27784, the provider must document the following information:

• Patient’s diagnosis and the need for surgical treatment
• Details of the procedure, including the specific fracture site and the use of internal fixation devices
• Date of the procedure
• Start and end time of the procedure
• Any additional procedures performed during the same surgical session
• Post-treatment X-rays, if taken
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 27784, ensure that the procedure meets the criteria for open treatment of a proximal fibula or shaft fracture with internal fixation. Use additional codes if other procedures are performed during the same surgical session. It is important to differentiate between internal and external fixation methods when reporting the procedure. Consider the use of modifier codes if necessary to accurately represent the services provided.

8. Historical information

CPT 27784 was added to the Current Procedural Terminology system on January 1, 1990. The code was later revised on January 1, 2008 to include the option of performing the procedure with or without internal or external fixation.

9. Examples

1. A provider performs open treatment of a proximal fibula fracture in a patient and uses plates and screws for internal fixation.
2. A patient sustains a shaft fracture in the fibula, and the provider performs open treatment with the use of wires for internal fixation.
3. A provider surgically fixes a proximal fibula fracture using pins for internal fixation.
4. A patient presents with a shaft fracture in the fibula, and the provider performs open treatment with the use of both plates and screws and wires for internal fixation.
5. A provider performs open treatment of a proximal fibula fracture and uses screws for internal fixation.
6. A patient requires surgical treatment for a shaft fracture in the fibula, and the provider performs open treatment with the use of plates for internal fixation.
7. A provider performs open treatment of a proximal fibula fracture and uses both plates and screws and pins for internal fixation.
8. A patient sustains a shaft fracture in the fibula, and the provider performs open treatment with the use of wires and pins for internal fixation.
9. A provider surgically fixes a proximal fibula fracture using screws and pins for internal fixation.
10. A patient presents with a shaft fracture in the fibula, and the provider performs open treatment with the use of plates, screws, and wires for internal fixation.