In particular, the FAOS is a useful tool for assessing outcomes in foot and ankle disorders,9 albeit imperfect.14 Importantly, the FAOS has been previously used as the primary outcome assessment for function in patients with type C pilon fractures treated by ORIF.8. While primary ORIF patients reported a similar degree of pain by both SF-36 and FAOS forms, patients who underwent primary fusion reported more intense pain by SF-36 as compared to FAOS. Outcomes reported by the Short Form 36-item health survey (SF-36). For the FAOS survey, we found equivalent outcomes in 4 of the 5 subscales (Figure 2). CPT code 28485-59 would be reported three times to represent each metatarsal fracture, per CPT description of the code. Fracture Care Coding per CPT® •Fracture care is a type of global “surgical” service. Since all primary fusion patients were deemed non-reconstructable, the baseline level of injury is likely worse for patients who undergo primary fusion compared to ORIF. A retrospective analysis of comminuted intra-articular fractures of the tibial plafond: open reduction and internal fixation versus external Ilizarov fixation, Fracture reduction and primary ankle arthrodesis: a reliable approach for severely comminuted tibial pilon fracture, Extraosseous blood supply of the tibia and the effects of different plating techniques: a human cadaveric study, Pin site care during circular external fixation using two different protocols, Type C tibial pilon fractures: short- and long-term outcome following operative intervention, Psychometric properties of the Foot and Ankle Outcome Score in a community-based study of adults with and without osteoarthritis, The operative treatment of complex pilon fractures: a strategy of soft tissue control, Management of high-energy tibial pilon fractures, Vascular abnormalities as assessed with CT angiography in high-energy tibial plafond fractures, Evaluation of the foot and ankle outcome score in patients with osteoarthritis of the ankle, The sequential recovery of health status after tibial plafond fractures, Salvage of tibial pilon fractures using fusion of the ankle with a 90 degrees cannulated blade-plate: a preliminary report, Reliability and validity of the Foot and Ankle Outcome Score: a validation study from Iran, Retrograde nail for tibiotalocalcaneal arthrodesis as a limb salvage procedure for open distal tibia and talus fractures with severe bone loss, Two-staged delayed open reduction and internal fixation of severe pilon fractures. SF-36 scores for the open reduction internal fixation (ORIF) patient cohort (n = 19) and fusion patient cohort (n = 16). 3190048988 While these 2 measures did not achieve statistical significance, the ORIF cohort was numerically younger in age and had a higher rate of nonunion, which could affect our outcome assessments. CPT code 28615 would be reported for the fixation of the dislocation. They often result in an obvious deformity of the ankle joint. Outcome assessment was determined by the Foot and Ankle Outcome Score (FAOS) and Short Form 36-item health survey (SF-36), time to radiographic union or fusion, and wound-healing complications at a minimum of 2 years after their surgery. Both physical and mental component summary scores were significantly lower in the fusion cohort. 1.000 Our rate of nonunion for primary ORIF is similar to rates reported in the literature.1,24 The current study did not assess alignment as an outcome measure. 0 All patients were ambulatory at the most recent follow-up visit. 1.000 Pilon fractures are caused by rotational or axial forces, mostly as a result of falls from a height or motor vehicle accidents. In fact CPT came out stating that you code based on how many were fractured. Patients who have suffered a displaced Pilon (Tibial Plafond) fracture(Figure 1)often benefit from surgery to reposition the bones that make up the top part of the ankle joint (Figure 2). The only significant difference observed was more severe symptoms in the fusion cohort. 7 Open fractures were classified by the Gustilo-Anderson classification system.12, Definitive outcome measurements were made at a minimum of 2 years of follow-up. In addition, the blade plate does not compromise the subtalar joint. You can be signed in via any or all of the methods shown below at the same time. Slate Pro It should not be used for HIPAA-covered transactions as a more specific code is available to choose from below. 0 Login failed. The average age of patients was 47 years, and 54 (56%) of the patients were men. All pilon fractures in both cohorts were classified as AO/OTA type C3. Primary fusion patients exhibited increased symptoms, pain, and physical role limits but were equivalent to primary ORIF patients on all other functional metrics examined. / The MT fractures are also treated by ORIF by separate incisions. xmp.did:0a8a9f0e-a373-4c07-9746-79c4ecc46d33 Patient databases were obtained from our institution for patients undergoing treatment for closed (International Classification of Diseases, Ninth Revision [ICD-9]: 824.8) and open (ICD-9: 824.9) ankle fractures. Open fractures are especially serious as the broken skin can lead to infection in both the wound and the bone. Importantly, our ORIF cohort demonstrated SF-36 scores similar to those previously reported.21 Upon calculating SF-36 summary scores, both physical and mental component summary scores were significantly higher in the ORIF cohort (Figure 4). 27828 - CPT® Code in category: Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more. A pilon fracture, is a fracture of the distal part of the tibia, involving its articular surface at the ankle joint. Emot, emotional; Funct, function; Gen, general; Phys, physical. Fixation consisted of a posterior blade plate, which was chosen over other hardware for multiple reasons. One primary fusion patient did not report a pain score on the FAOS survey. Thus, we determined the clinical effects of routine hardware removal irrespective of the degree of hardware-related pain, especially in the perspective of patients’ daily activities. Nonunion was defined as failure to achieve definitive union accompanied by absence of progressive healing on serial radiographs. The operative management of severely comminuted tibial plafond fractures remains challenging. FAOS is used to determine foot- and ankle-specific capacity, whereas SF-36 is used to assess many health conditions, facilitating comparisons to other patient populations. Thirteen primary fusion patients underwent temporary external fixation. S82.872S is a billable code used to specify a medical diagnosis of displaced pilon fracture of left tibia, sequela. Please check you selected the correct society from the list and entered the user name and password you use to log in to your society website. false Sequence of bone stabilization. AO teaching video: Tibia, Distal — Pilon Fracture — Fixation with LCP-Distal Tibia Plate and LCP One-third Tubular Plate 3.5. FAOS and SF-36 form responses were compiled for each cohort. Representative radiographic images are shown for pre- and postoperative type C3 pilon fractures treated with either primary ORIF (Figure 1A-D) or fusion (Figure 1E-H). These high-energy distal tibial fractures often present with substantial soft tissue injury and significant articular cartilage impaction.20 In addition, these injuries commonly result in end-stage posttraumatic arthritis (PTA) or infection, prolonged return to work, significant pain, and the need for further operative intervention, including amputation.3 Previous studies in patients with type B3 to C3 pilon fractures reported daily pain experienced by up to 66% of patients.25. S82.87 - Pilon fracture of tibia Version 2021 Non-Billable Code Not Valid for Submission S82.87 is a "header" nonspecific and non-billable code code, consider using a code with a higher level of specificity for a diagnosis of pilon fracture of tibia. definitive fixation for majority of pilon fractures Previously, we found comparable outcomes in our primary fusion cohort and historical primary ORIF controls.28 However, this comparison lacked statistical robustness (historical controls did not report variance), did not account for interinstitutional variability, and included several patients with type C2 fracture patterns, which do not present with as much articular comminution as type C3 injuries. Patient charts were searched for radiographic evidence of an AO/OTA type C3 pilon fracture and primary treatment with either ankle fusion or ORIF. Fracture pattern was classified according to the AO/OTA classification system. Deleted codes 27193 and 27914 were generic and simply referred to “pelvic ring fracture, dislocation(s), diastasis or subluxation. don't say that ALL have to be ORIFed in order to report. Collected parameters included age, sex, mechanism of injury, fracture pattern, open or closed fracture, and associated comorbidities. default temporizing spanning external fixation across ankle joint . I have read and accept the terms and conditions, View permissions information for this article. Access to society journal content varies across our titles. In cases of comminuted impacted fractures (“pilon”), bone graft from the distal radius is needed to fill the metaphyseal defect. 0 Posttraumatic arthritis was observed in 11 of 19 primary ORIF patients. indications . The e-mail addresses that you supply to use this service will not be used for any other purpose without your consent. Associated skin complications are frequent as those of surgery of this pattern. xmp.did:05d8e06f-c27c-4db7-ab06-766da5b197a4 Short Form 36-item health survey (SF-36) calculated summary scores. Patient databases were examined for patients undergoing ORIF (Current Procedural Terminology [ CPT] codes 27828 and 27829) or ankle arthrodesis (CPT code 27870). Staged treatment using bridging external fixation followed by definitive internal fixation presents lower infection risk than external fixation and fewer wound complications than acute ORIF.2,10,19 However, even with adequate reduction, rates of nonunion and PTA can be as high as 70%28 and 81%,3 respectively. One weakness of this study is the relatively small sample size and varied nature of the accompanying treatment to the definitive fixation method. xmp.iid:f6deefeb-42e9-4eb4-82d5-85a43c7364e3 Adobe InDesign CC 14.0 (Macintosh) While primary fusion patients reported more severe physical role limits and pain, all mental health, physical function, and general health subscales were equivalent between both groups. 27825 - CPT® Code in category: Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more. False If the fibula is not properly attached to the tibia, the joint will not be congruent. **P < .01. Populations were compared using Wilcoxon Mann-Whitney rank sum to determine significant differences between scores for each category. 0 Upon correct insertion into the talus, parallel to its axis, the tibia achieves proper alignment. One patient developed severe regional pain syndrome requiring extensive medical management. 3190048988 2. Remember Modifier -58 for Staged Pilon Fracture Treatment Published on Wed Mar 12, 2014 Question: Our surgeon stabilized a pilon fracture using an external fixator and operated to fix the fibular fracture. Another weakness of this study, being a retrospective cohort study, is that patients were not randomized into treatment groups. Unanswered questions in the SF-36 surveys did not influence the scoring. Five patients in the fusion cohort and 4 patients in the ORIF cohort had open fractures, as classified by Gustilo and Anderson,12 ranging from type I to type III-B. Mean follow-up time was 5.5 years (range, 2-9 years) for the ORIF cohort and 6.9 years (range, 2-13 years) for the fusion cohort. Preoperative and follow-up radiographic evaluation. Additional inclusion criteria for the fusion cohort were patients whose fractures were deemed non-reconstructable by the treating surgeon. 9ec7c033442fdf52f59ec073bdba0979209115be These features of pelvic fractures clearly indicate why the new CPT codes were necessary. Cavusoglu, AT, Er, MS, Inal, S, Ozsoy, MH, Dincel, VE, Sakaogullari, A. Duckworth, AD, Jefferies, JG, Clement, ND, White, TO. Union was achieved from the primary procedure in 14 of 19 ORIF patients and 15 of 16 primary fusion patients. Swelling occurs quickly and can be followed by bruising. Demographic patient data were collected from patients’ charts. Articular congruity should be restored anatomically. Three of these 5 patients receiving autograft were supplemented with bone morphogenetic protein (BMP) when there were large osseous voids. Pilon fractures are often severe injuries that can permanently affect the ankle joint. Introduction . A fracture of the distal end of the fibula is a broken bone in the smaller bone of the lower leg. loss of motion; post-traumatic arthrosis. 2825763434 Scatterplots for pain scores obtained by SF-36 and FAOS were linearly fitted using GraphPad Prism 7 (GraphPad Software, La Jolla, CA), and the fit parameters and goodness of fit (R2) are reported. This year, orthopedists need to pay attention to the changes to pelvic fracture coding. This study was conducted on 80 consecutive cases (78 patients) treated by surgery and hardware removal after bony u… OpenType - PS All patients had at least 2 years of follow-up since their procedure. Despite more severe injuries in patients receiving primary fusion than those in whom reconstruction could be attempted, the functional outcomes between both patient populations are similar. Since both FAOS and SF-36 assess pain, we were interested if pain was reported similarly by both surveys. Approval to conduct this study was received from our institutional review board. CPT® Code Description Internal Fixation (cont.) While ORIF patients reported pain similarly on both surveys (linear slope of 0.94), primary fusion patients reported more severe pain on the SF-36 survey (linear slope of 0.78). Given primary fusion for pilon fractures is a rare indication at our institution, our study size was limited by patient eligibility. 3/24/2014 7 IM (intramedullary) rodding Bone is opened remote from the fracture site o Rod is placed down the intramedullary canal o Often screw fixation is placed at the proximal and distal ends to prevent movement of the rod Fracture is visualized only by x-ray If no CPT code descriptor for IM rodding should be coded as open o CPT Musculoskeletal System Chapter guidelines Linear regression analysis for each cohort was performed. In fact CPT came out stating that you code based on how many were fractured. OpenType - PS FAOS scores for the open reduction internal fixation (ORIF) patient cohort (n = 19) and fusion patient cohort (N = 16). The tibiotalar joint was packed with posterior iliac crest autograft for all fusion patients. All patients fifteen years or older treated definitively with ORIF of pilon fractures at our institution between January 1, 2006 and December 31, 2011 were identified from an institutional billing database. The average follow-up was 2 years for patients included in this study. While primary fusion patients reported worse ankle symptoms, no significant difference in pain, quality of life, sports and recreation, or activities of daily living was observed. Pilon fracture of the ankle is an intra-articular fracture of the distal tibial metaphysis that occurs in approximately 7% of tibial fractures. 2019-01-09T10:53:58.000-06:00 The slope, y-intercept (Y-int), and coefficient of determination (R2) for each fit are reported below its respective population. 2019-01-14T15:41:28.178-06:00 ICMJE forms for all authors are available online. Follow-up time was defined as the period between the patient’s completion of the SF-36 and FAOS surveys and his or her initial definitive operative procedure (ORIF or fusion). Figure 5. Of the remaining 3 ORIF patients, 2 did not have a fibula fracture. Scores for the open reduction internal fixation (ORIF) patient cohort (n = 19) and fusion patient cohort (n = 16) are represented by the inner-quartile range (box) and mean (line), with error bars representing the range of the data. Simply select your manager software from the list below and click on download. Figure 4. By continuing to browse We hypothesize that primary ORIF will yield better functional outcomes than primary arthrodesis for highly comminuted type C3 pilon fractures due to preservation of the tibiotalar joint. Find out about Lean Library here, If you have access to journal via a society or associations, read the instructions below. Eleven of 19 patients in the ORIF cohort had developed posttraumatic ankle arthritis by their most recent follow-up visit. Another strength of this study is the use of robust statistical analysis to determine differences between these 2 patient cohorts. All pilon fractures in both cohorts were classified as AO/OTA type C3. The other 3 primary fusion patients were initially splinted to allow for soft tissue swelling to diminish. Contact us if you experience any difficulty logging in. Create a link to share a read only version of this article with your colleagues and friends. indications . Foot and Ankle Systems Coding Reference Guide Open reduction with internal fixation (ORIF) remains the basis by which most pilon fractures are operatively stabilized. SlatePro-Bold Nineteen primary ORIF patients and 16 primary fusion patients completed the SF-36 and FAOS forms. The slope demonstrates the amount to which patients report similar pain on FAOS and SF-36, with a slope of 1.0 signifying equivalent pain by both surveys, a slope more than 1.0 signifying more intense pain by FAOS, and a slope less than 1.0 signifying more intense pain by SF-36. Figure 3. Fibula or tibia first? In contrast to our hypothesis, outcomes for primary ORIF and primary fusion were similar for many FAOS and SF-36 subscales. *P < .05. Moreover, primary arthrodesis with blade plate fixation precludes ankle arthroplasty in a select group of patients with well-aligned pilon fractures that progress to posttraumatic arthritis. Union rates were compared with a Fisher exact test, with a significance level of P < .05. View or download all the content the society has access to. Patients that are healthy and do not have any contraindicatio… One nonunion in the ORIF cohort was complicated by a history of diabetes. Ability of modern distal tibia plates to stabilize comminuted pilon fracture fragments: is dual plate fixation necessary? The only 2 significant differences observed were more severe physical role limits and pain in the fusion cohort. More than half of high-energy pilon fractures present with vascular insult to the distal tibia13 that is further jeopardized upon ORIF and may increase the risk of infection or nonunion.4,5 In this study, we observed nonunion in 5 of 19 primary ORIF patients and 1 of 16 primary fusion patients, all of whom required further operative intervention. The goal of surgery is to put the bones back into the position that they were in prior to the injury. Slate Pro Inclusion criteria for the ORIF cohort were patients with an AO/Orthopaedic Trauma Association type C3 pilon fracture. To code a diagnosis of this type, you must use specify a 7th character that describes the diagnosis 'displaced pilon fracture of right tibia' in more detail. Primary ankle arthrodesis achieves a lower rate of nonunion and comparable functional outcomes to ORIF in patients with severely comminuted pilon fractures. Five primary ORIF patients received autograft, all during secondary operative intervention for primary nonunion. Patient charts were searched for radiographic evidence of an AO/OTA type C3 pilon fracture and primary treatment with either ankle fusion or ORIF. The ankle joint involves the tibial-fibular mortise and talus. Figure 2. If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Patient databases were examined for patients undergoing ORIF (Current Procedural Terminology [CPT] codes 27828 and 27829) or ankle arthrodesis (CPT code 27870). Operative parameters were also collected, including use of a temporary external fixator, use of bone graft, fixation of associated fibula fracture, and date of primary definitive treatment. 27422 - Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; without fixation To determine whether patients report pain differently on the 2 surveys, we linearly correlated pain scores determined by SF-36 and FAOS (Figure 5). Functional outcomes were measured using 2 health surveys, the Short Form 36-item health survey (SF-36) and the Foot and Ankle Outcome Score (FAOS) survey. Pilon fractures are very painful and debilitating injuries. Operative complications in the primary fusion cohort included 1 deep vein thrombosis (all patients received baseline anticoagulation). Due to the high incidence of PTA and pain that result from highly comminuted pilon fractures, we sought to explore arthrodesis as the primary treatment for a very unique subset of patients with significant articular comminution and impaction. The purpose of this study is to compare primary ankle arthrodesis with patients who received primary ORIF for a subset of type C3 pilon fractures at a single institution.