# Left ankle hardware removal and revision fixation.



## KatieGal (Feb 11, 2009)

Can someone help with this one please -    I was looking at the code 27762 for a nonunion/malunion but not sure if this is correct.  With this code, I would not bill the hardware removal or should I???

DX:  Left bimalleolar ankle fracture status post open reduction internal fixation with failure of fixation and widened ankle mortise.  

Proc:  Left ankle hardware removal and revision fixation.  

An incision was made over the previously made site at the lateral aspect of the fibula.  Dissection continued down through subcutaneous tissue to the level of the fibula fracture site and the plate.  The plate was removed.  Excess scar tissue was removed from the fracture area.  There was a small articular surface defect in the lateral talar dome where the proximal portion of the fibular fracture was digging into the talus as it slid laterally. There were no loose articular flaps of cartilage that had to be d?brided, however, and this was a less than 3 mm defect.  The fracture was reduced and a 6-hole one-third tubular plate, locking small fragment plate, was placed over the lateral aspect of the fibula.  Two holes were placed distal to the fracture site as that was as much as could be obtained because of the distal nature of the fracture.  Attempt was made to place screws into the fracture site and poor fixation was obtained and the mortise was not closing down.  Therefore, decision was made to place the screws proximal to the fracture site, across the syndesmosis, to gain fixation through additional bone in the tibia.  Therefore, 5 screws were placed in this fashion which resulted in progressive closure of the ankle mortise.  The 2 distal screws were then placed in the distal fragment in locking fashion.  All proximal screws were placed in nonlocking fashion because we wanted to gain compression to close down the medial joint space and, therefore, they could not be placed in locking fashion.

Thank you - Kate


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## mbort (Feb 11, 2009)

I would use 27814.  Even though the 20680 does not bundle with the 27814, the surgeon had to remove the hardware (incidental) before he could re-fix this fracture therefore I would not award coding for it.

my two cents
Mary, CPC, COSC


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## KatieGal (Feb 12, 2009)

I'm sorry, the code I was looking at was 27726 - Repair of fibula nonunion and/or malunion with internal fixation.

Thank you for you input Mary - it helps to have other eyes on some of these op notes.

Kate


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