# Percutaneous fixation of medial malleolus



## sdomel159 (Jul 3, 2013)

Good morning, I was thinking 27814 would not be accurate in this case and I should report:  27792 with 27762 - would that be correct?  Thanks for your help!

Here is the operative report:

Patient was taken to the operating room and placed supine on the operating table where a laryngeal mask anesthetic was induced. The left lower extremity was prepped and draped in sterile fashion. Pneumatic tourniquet was raised after the extremity was exsanguinated. A longitudinal incision was made over the fibula, centered over the fracture. Dissection was carried through subcutaneous tissue sharply. Fascia was divided in line with the incision. The peroneal tendons were retracted posteriorly, exposing the fibula fracture. There was 50% lateral displacement of the distal fragment. It was a fairly transverse fracture. I attempted to distract fragments and realign them, but ultimately I had to use a Freer elevator to lever the distal fragment into position. After I gained satisfactory reduction, I checked fluoroscopically for good alignment. I then placed a 6-hole 1/3 tubular plate with two bicortical screws distally, followed by a compression screw proximally and filled out the rest of the holes statically with bicortical screws. When I looked at the medial side fluoroscopically, there was still a few millimeters of displacement. He had a significant abrasion over the medial malleolus, which precluded any open surgery here. There was an area of normal skin distal to the tip of the medial malleolus. I decided to manipulate the fracture closed and do percutaneous screws. Two small K wires were placed through normal skin in the tip of the malleolus, crossing the fracture. These were drilled and filled with 4-0 partially threaded cancellous screws. Good compression was noted. Excellent alignment was noted. Wound was irrigated copiously with normal saline and closed in layers. Sterile dressing was applied followed by a posterior splint and stirrup. The patient was awakened and taken to the recovery room in stable condition.


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## KimberlySherman (Jan 24, 2022)

In my opinion, a bimalleolar fracture repair would be coded: *27814 *_Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli), includes internal fixation, when performed_. The requirements of the description are met - an open approach was used on the lateral malleolus, and both the lateral and medial malleoli were fixated.


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## amyjph (Jan 26, 2022)

I agree with Kimberly.


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