Open treatment of distal fibular fracture (lateral malleolus)

CPT 27792 is the billing code for "Open treatment of distal fibular fracture (lateral malleolus)". For open treatment of distal fibular fracture (lateral malleolus)

Medicare pays approximately $637.55 for CPT 27792 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.

CPT 27792 has a total RVU of 32.20, broken down as: Work RVU 14.00, Practice Expense RVU 16.80, and Malpractice RVU 1.40. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 27792 include: Indication for open treatment; Fracture type and location; Surgical approach; Hardware used. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 27792: Includes open treatment. Includes internal fixation Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 27792 include: 50 (Bilateral procedure when both ankles performed same session), 51 (Multiple procedures performed same session), 22 (Increased procedural services for complex cases). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 27792 is 60-90 minutes typical operative time. Time-based codes require documentation of the actual time spent providing the service.