Open surgical repair of a trimalleolar ankle fracture — all three malleoli (medial, lateral, and posterior) — with internal fixation applied to the posterior lip in addition to the medial and/or lateral malleolus.

Verified May 8, 2026 · 6 sources ↓

Medicare: $923.20
Total RVUs: 27.64
Global, days: 90
Region: Foot & ankle

Drawn from AAPCCMSFindacode

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Explicit statement that the posterior malleolus (posterior lip) was fixated — not just exposed or assessed
Identification of all three malleoli fractured: medial, lateral, and posterior
Fixation method and hardware described for each malleolus (plates, screws, wires, or pins)
Laterality documented (left vs. right ankle) to support LT/RT modifier assignment
Fracture pattern and instability rationale supporting open surgical intervention over closed management
Operative note specifying surgical approach and reduction technique for each fracture fragment

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27823 covers open treatment of a trimalleolar ankle fracture where the surgeon fixes the posterior malleolus (posterior lip of the tibia) in addition to the medial and/or lateral malleolus. That posterior fixation is the single element that separates 27823 from 27822 — if the posterior lip is addressed but not fixated, bill 27822 instead. Typical fixation constructs use plates, screws, wires, or pins across two or more malleoli, with the posterior fragment stabilized based on fragment size, displacement, and articular involvement.

The 90-day global period covers the operative day, the day-before visit if applicable, and all routine post-op care through day 90. Casting, splinting, and strapping applied at the time of surgery are bundled and cannot be billed separately per NCCI policy. Any subsequent procedure for hardware removal (CPT 20680) falls outside the global only if it's separately indicated and documented as distinct.

The code sits in a well-defined family: 27816/27818 for closed trimalleolar treatment, 27822 for open without posterior lip fixation, and 27823 for open with posterior lip fixation. Payer downcoding from 27823 to 27822 is a known audit pattern — operative notes must explicitly document that the posterior malleolar fragment was fixated, not merely visualized or assessed.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	12.83
Practice expense RVU	12.28
Malpractice RVU	2.53
Total RVU	27.64
Medicare national rate	$923.20
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	$923.20
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,829.98

Common denial reasons

The recurring reasons claims for CPT 27823 get rejected.

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

Payer downcodes to 27822 when operative note does not explicitly confirm posterior lip fixation
Casting or strapping billed separately on same date — bundled under NCCI policy for fracture repair codes
Missing laterality modifier (LT or RT) triggering claim rejection or payer edit
ICD-10-CM diagnosis code does not confirm trimalleolar fracture pattern, creating CPT-diagnosis mismatch
Post-op E&M visits billed without modifier 24 during the 90-day global period

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What is the difference between 27822 and 27823?

The only distinction is posterior lip fixation. Use 27822 when the posterior malleolus is not fixated. Use 27823 when it is. If your op note doesn't state fixation of the posterior lip explicitly, expect a downcode to 27822.

02Can I bill casting or splinting separately with 27823?

No. NCCI policy bundles casting, splinting, and strapping into fracture repair codes. Billing a strapping code like 29581 alongside 27823 on the same date will be denied.

03What global period applies to 27823?

90-day global. All routine post-op visits, wound checks, and dressing changes through day 90 are included. Bill unrelated E&M services during that window with modifier 24.

04When is modifier 22 appropriate for 27823?

When operative complexity is substantially greater than typical — for example, severely comminuted fragments, prior hardware removal required before fixation, or significantly prolonged operative time. Document the specific factors driving increased complexity; a blanket claim of difficulty won't support it.

05Can 27823 be billed with 27829 (syndesmosis repair) on the same day?

Yes, when the syndesmosis is separately addressed and documented. Apply modifier 59 or XS to the secondary code to indicate a distinct service. Confirm there is no active NCCI edit pairing these codes before billing.

06How should I handle a planned second-stage procedure during the global period?

Use modifier 58 for a staged or related procedure performed by the same surgeon during the 90-day global. This resets the global period for the new procedure. Modifier 78 applies only to an unplanned return to the OR for a related complication.

07Is 27823 typically performed inpatient or outpatient?

Both settings are used. Common places of service are inpatient hospital (21) and on-campus outpatient hospital (22). Site of service affects the facility payment rate — see the HOPD vs. ASC comparison on this page.

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 specific malleoli fractured, the fixation method applied to each (including explicit confirmation that the posterior lip was fixated), the surgical approach, and laterality — directly from dictation. That prevents the most common denial for 27823: payer downcoding to 27822 because the operative note documented posterior malleolus involvement without clearly stating it was fixated.

See how Mira captures CPT 27823 documentation