How To Use CPT Code 27826

CPT 27826 describes the open treatment of a fracture of the weight bearing articular surface or portion of the distal tibia, specifically the fibula, with internal fixation. 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 27826?

CPT 27826 is used to describe the open treatment of a fracture in the weight bearing articular surface or portion of the distal tibia, specifically the fibula. This procedure involves surgically fixing the fracture by securing the fibula with plates and screws, wires, or pins. It is typically performed on unstable fractures that require additional support.

2. Official Description

The official description of CPT code 27826 is: ‘Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of fibula only.’

3. Procedure

1. The provider prepares the patient and administers anesthesia as necessary.
2. An incision is made at the ankle joint to access the fracture site.
3. The provider identifies and explores the fracture site, focusing on the fibula.
4. Internal fixation is applied to the fibula using plates and screws, wires, or pins.
5. The site is irrigated to clean it, and hemostasis is achieved to stop any bleeding.
6. The incision is closed, and a cast or brace may be applied to stabilize the fracture.
7. Post-treatment X-rays may be taken to ensure proper alignment.

4. Qualifying circumstances

CPT 27826 is performed on patients with fractures in the weight bearing articular surface or portion of the distal tibia, specifically the fibula. The procedure is typically reserved for unstable fractures that require additional support. It involves the use of internal fixation, such as plates and screws, wires, or pins, to secure the fibula and retain the fractured fragments of the cartilage surface of the tibia in the correct anatomical position.

5. When to use CPT code 27826

CPT code 27826 should be used when the provider performs open treatment of a fracture in the weight bearing articular surface or portion of the distal tibia, specifically the fibula, with internal fixation. It is important to note that this code is specific to the fibula only. If the procedure involves the tibia or both the tibia and fibula, a different code should be used.

6. Documentation requirements

To support a claim for CPT 27826, the provider must document the following information:

• Patient’s diagnosis and the need for open treatment of the fracture
• Details of the procedure, including the specific fracture site and the use of internal fixation
• Date of the procedure
• Any additional procedures or treatments performed during the same session
• Post-treatment X-rays, if applicable
• Signature of the provider

7. Billing guidelines

When billing for CPT 27826, ensure that the procedure meets the criteria for open treatment of a fracture in the weight bearing articular surface or portion of the distal tibia, specifically the fibula, with internal fixation. It is important to accurately document the procedure and any additional services provided during the same session. Be aware of any specific billing guidelines or modifiers that may apply to ensure proper reimbursement.

8. Historical information

CPT 27826 was added to the Current Procedural Terminology system on January 1, 1993. There have been historical changes to the code, including a code change on January 1, 2008, which expanded the description to include internal or external fixation of the fibula only.

9. Examples

1. A provider performs open treatment of a fracture in the weight bearing articular surface of the distal tibia, specifically the fibula, using internal fixation.
2. During a surgical procedure, a provider fixes a fracture in the weight bearing portion of the distal tibia, specifically the fibula, with plates and screws.
3. A patient undergoes open treatment of a fracture in the articular surface of the distal tibia, specifically the fibula, with internal fixation to stabilize the fracture.
4. A provider performs surgery to fix a fracture in the weight bearing portion of the distal tibia, specifically the fibula, using wires and pins for internal fixation.
5. During a surgical procedure, a provider secures a fracture in the articular surface of the distal tibia, specifically the fibula, with plates and screws for internal fixation.
6. A patient undergoes open treatment of a fracture in the weight bearing portion of the distal tibia, specifically the fibula, with internal fixation to promote proper healing.
7. A provider performs surgery to fix a fracture in the articular surface of the distal tibia, specifically the fibula, using wires and pins for internal fixation.
8. During a surgical procedure, a provider secures a fracture in the weight bearing portion of the distal tibia, specifically the fibula, with plates and screws for internal fixation.