Open surgical repair of a trimalleolar ankle fracture with internal fixation applied to the medial and/or lateral malleolus, but without fixation of the posterior lip.
Verified May 8, 2026 · 7 sources ↓
- Medicare
- $826.34
- Total RVUs
- 24.74
- Global, days
- 90
- Region
- Foot & ankle
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 7 cited references ↓
- Confirm all three malleoli were fractured (medial, lateral, and posterior) — trimalleolar designation must be supported by imaging and intraoperative findings
- Explicitly document that internal fixation was applied to the medial and/or lateral malleolus only, with no fixation performed on the posterior lip
- Specify the type and placement of fixation hardware (e.g., plate and screws at lateral malleolus, screw at medial malleolus)
- Document fracture displacement or instability as the clinical justification for open treatment over closed management
- Record laterality (left vs. right ankle) in both the operative note and the claim
- Note the surgical approach used — do not use generic language like 'standard approach'; name the incision site and technique
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 7 cited references ↓
CPT 27822 covers open treatment of a trimalleolar ankle fracture — meaning all three malleoli (medial, lateral, and posterior) are fractured — where the surgeon applies internal fixation (plates, screws, wires, or pins) to the medial and/or lateral malleolus but leaves the posterior lip unfixed. That distinction from 27823 (which includes posterior lip fixation) is the critical code-selection fork. Use 27822 when the posterior fragment is small enough or stable enough that fixation is not warranted.
The 90-day global period governs all routine post-op care from the day of surgery through day 90. That includes wound checks, dressing changes, cast or splint management, and suture removal. Separate billing of any casting or strapping code alongside 27822 is prohibited under NCCI — fracture codes include the initial immobilization. If a subsequent unrelated procedure is needed during the global window, append modifier 79.
The code sits in a trimalleolar family: 27816 and 27818 cover closed treatment without and with manipulation, respectively; 27822 is the open/no-posterior-fixation variant; and 27823 adds fixation of the posterior lip. Accurately distinguishing among these based on operative findings — not just preoperative imaging — is the basis for correct code selection and audit defense.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 10.93 |
| Practice expense RVU | 11.67 |
| Malpractice RVU | 2.14 |
| Total RVU | 24.74 |
| Medicare national rate | $826.34 |
| 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 | $826.34 |
HOPD (APC 5114) Hospital outpatient department | $7,413.38 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $4,821.39 |
Common denial reasons
The recurring reasons claims for CPT 27822 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Upcoding to 27822 when operative note only documents bimalleolar fixation — missing documentation of the third (posterior) malleolus fracture
- Billing 27823 vs. 27822 confusion — payers audit operative notes for presence or absence of posterior lip fixation; mismatched coding triggers denial or downcoding
- Casting or strapping code (e.g., 29581) billed on the same claim — NCCI bundles initial immobilization into the fracture repair code
- Missing laterality modifier (LT or RT) on the claim, triggering rejection or manual review by payer
- E&M service billed same day without modifier 25 and documentation of a significant, separately identifiable decision beyond the fracture care itself
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 7 cited references ↓
01What is the difference between 27822 and 27823?
02Can I bill a casting or splinting code alongside 27822?
03Does 27822 require a laterality modifier?
04What global period applies to 27822, and what does it include?
05Can an E&M be billed on the same day as 27822?
06When is modifier 22 appropriate with 27822?
07Can 27822 be billed with an ankle dislocation repair code (e.g., 27846)?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/files/document/2026-ncci-medicaid-policy-manual.pdf
- 03cms.govhttps://www.cms.gov/files/document/2026-medicaid-ncci-chapter-4-policy-manual.pdf
- 04cms.govhttps://www.cms.gov/files/document/2026-medicaid-ncci-chapter-1-policy-manual.pdf
- 05emedny.orghttps://www.emedny.org/providermanuals/physician/pdfs/physician%20procedure%20codes%20sect5.pdf
- 06cms.govhttps://www.cms.gov/medicare/regulations-guidance/physician-self-referral/list-cpt-hcpcs-codes
- 07findacode.comhttps://www.findacode.com/cpt/27822-cpt-code.html
Mira AI Scribe
Mira's AI scribe captures the specific malleoli fractured, the fixation hardware applied to each, and the explicit absence of posterior lip fixation from the surgeon's dictation — the exact language needed to defend 27822 over 27823. It also flags laterality and approach documentation, preventing the two most common audit triggers: missing posterior malleolus fracture confirmation and unspecified surgical approach.
See how Mira captures CPT 27822 documentation