Open treatment of bimalleolar ankle fracture

CPT 27814 is the billing code for "Open treatment of bimalleolar ankle fracture". For open treatment of bimalleolar ankle fracture

Medicare pays approximately $754.64 for CPT 27814 (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 27814 has a total RVU of 46.75, broken down as: Work RVU 20.50, Practice Expense RVU 24.20, and Malpractice RVU 2.05. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 27814 include: Indication for open treatment; Fracture type and location; Both malleoli involved; Surgical approach. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 27814: Includes open treatment. Includes internal fixation of both malleoli Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 27814 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 27814 is 90-120 minutes typical operative time. Time-based codes require documentation of the actual time spent providing the service.