Open surgical repair of a distal fibula fracture at the lateral malleolus, with internal fixation (plate, screws, or pins) when performed.

Verified May 8, 2026 · 7 sources ↓

Medicare: $607.90
Total RVUs: 18.2
Global, days: 90
Region: Foot & ankle

Drawn from AAPCNIHMedicalbillgurusAcgmeAAOS

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 7 cited references ↓

Specify that treatment was open (or percutaneous with direct visualization), not closed — this determines the code family
Document that the fracture involves the distal fibula at the lateral malleolus specifically, not the fibular shaft or proximal fibula
Record fixation hardware used: plate and screws, wires, pins, or percutaneous implants, including sizes and manufacturers when applicable
Note laterality (left vs. right ankle) explicitly in the operative report to support LT/RT modifier billing
Include fluoroscopic or intraoperative imaging confirmation of fracture reduction and hardware placement
Document fracture classification (e.g., Weber A/B/C or Lauge-Hansen pattern) to support medical necessity and audit defense
If only one malleolus was treated, document why bimalleolar or trimalleolar codes do not apply — particularly when a second incision is present

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 50 Bilateral procedure 51 Multiple procedures 58 Staged or related 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 27792 covers open treatment of a distal fibular fracture at the lateral malleolus. The surgeon makes a lateral ankle incision, exposes the fractured fibula, reduces the fragments, and stabilizes them with internal fixation hardware — typically a plate and screws, though wires or pins may be used. Note that percutaneous fixation still qualifies as open treatment for coding purposes under this code.

This code sits within the lateral malleolus fracture family. For closed treatment without manipulation, use 27786; with manipulation, use 27788. Once the surgeon opens the fracture site or applies internal fixation percutaneously, 27792 is the correct code. If both the lateral and medial (or posterior) malleoli are treated, step up to the bimalleolar code 27814. Trimalleolar fixation goes to 27822 or 27823 depending on whether the posterior lip is fixed.

27792 carries a 90-day global period. Routine post-op visits, wound checks, cast changes, and hardware monitoring within that window are bundled. An E/M during the global for a separate problem needs modifier 24. If the patient returns to the OR for a related complication — say, hardware failure requiring revision — append modifier 78. A staged second procedure planned at the time of the index surgery (e.g., delayed weight-bearing hardware removal) takes modifier 58, which resets the global clock.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.53
Practice expense RVU	8.06
Malpractice RVU	1.61
Total RVU	18.2
Medicare national rate	$607.90
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$607.90
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,813.11

Common denial reasons

The recurring reasons claims for CPT 27792 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Code mismatch with ICD-10: billing 27792 against a medial malleolus or bimalleolar fracture diagnosis without supporting the lateral malleolus site
Upcoding to bimalleolar (27814) or downcoding to closed treatment (27786/27788) when operative report details contradict the submitted code
Missing laterality modifier — payers increasingly require LT or RT for unilateral ankle procedures; absence triggers suspense or denial
Global period conflict: E/M or follow-up visit billed in the 90-day window without modifier 24 or 25, resulting in automatic bundling rejection
Modifier 78 applied to a planned staged return when modifier 58 was required, causing global period and payment calculation errors
Lack of medical necessity documentation: op note describes a fracture pattern manageable with closed treatment but open surgery was performed without documented clinical rationale

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Does percutaneous fixation of a distal fibula fracture still use 27792?

Yes. Percutaneous fixation qualifies as open treatment under this code family. The determining factor is whether the fracture was approached with direct surgical access or fixation hardware — not whether a large incision was made.

02When does a lateral malleolus fracture step up to a bimalleolar code?

When the surgeon fixes both the lateral malleolus and a second malleolus (medial or posterior) in the same session, report 27814 instead of 27792. If you operated on only the lateral malleolus but the patient had a two-malleolus fracture pattern, document clearly why the second malleolus was not surgically addressed.

03What modifier do I use for a planned staged procedure during the 90-day global?

Use modifier 58 for a staged or related procedure the surgeon planned at the time of the original surgery — for example, a scheduled hardware removal. Modifier 58 resets the global period. Do not use modifier 78 for planned returns; 78 is for unplanned returns to the OR for related complications.

04Can 27792 be billed bilaterally?

Bilateral ankle fracture repair in a single session is uncommon but codable. Append modifier 50 if performed bilaterally, or use LT and RT on separate line items per payer preference. Confirm with the individual payer whether they accept modifier 50 or require split billing — this is payer-variable.

05How does 27792 relate to 27786 and 27788?

All three codes treat a lateral malleolus fracture. 27786 is closed treatment without manipulation; 27788 is closed treatment with manipulation; 27792 is open treatment including internal fixation when performed. The selection is driven by the operative approach documented in the record, not the fracture severity.

06What ICD-10 codes pair with 27792?

The primary ICD-10 diagnosis should specify a distal fibula or lateral malleolus fracture with laterality — for example, S82.6 series (lateral malleolus fracture). Pairing 27792 with a medial malleolus or pilon fracture ICD-10 without supporting documentation is a common denial trigger.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the surgical approach (lateral incision, direct fracture visualization), fracture site (distal fibula, lateral malleolus), reduction method, and fixation construct (hardware type, size, configuration) directly from dictation. It also flags laterality and records whether percutaneous fixation was used — the detail that separates 27792 from closed treatment codes. This prevents the most common audit trigger: an operative note that says 'open ORIF ankle' without specifying the malleolus treated or the fixation method applied.

See how Mira captures CPT 27792 documentation