# new coder needs help



## ggparker14 (Nov 23, 2010)

I have a case where there  is a left ankle trimalleolar fracture and left ankle syndemosis.  The doc does ORIF left ankle , 27822 and a ORIF left ankle syndesmosis, 27829. I am wanting to know if the syndesmosis is bundled in with the 27822. 

 My dictation reads: Incision was fashioned over the laterial aspect of the fibula taking care to protect surrounding neurovascular structures in particular the superficial peroneal nerve. The fracture ws identified over the distal one third of the fibula. It was held in position with a bone clamp.  Some small amount of periosteum was removed from the edge of the fibula around the edge of the fracture. An interfragmentary screw was then drilled, measured and appropriate screw length applied across the fracture. An eight hole one-third semitubular plate was then prebent and contoured to the distal fibula. A nonlocking screw was drilled and placed proximal and distal to the fracture.  Additional screw holes were filled with locking screws leaving two screw holes open around the fracture site and along the area of the interfragmentary screw. One screw hole was left in the second most distal screw hole to place the syndesmosis screw. Attention was next turned to the medial malleolus. An anteromedial incision was fashioned over the medial malleolus. Care was taken to protect the saphenous vein and nerve. The fracture was reduced and held with a bone holding clamp. It was subsequently then pinned with two guidepins for the 4.0 mm cannulated screws. Image intensification confirmed good position of the guidewires on AP, lateral and cannulated screws with washers were placed. The guide pins were removed. Image intensification confirmed good position of the medial malleolar screws. Attention was next turned back to the scyndesmosis screw. With the ankle held in neutral to dorsiflexion the second to distal most screw hole was left open, and the plat was subsequently drilled with the 2.5 mm drill bit aiming slightly anterior for the fibular to the bibia. This was measured and a 50 mm 3.5 mm fully threaded cortical screw was placed. Care was taken to provide manual pressure over the medial aspect of the ankle to avoid any gap at the medial mortise.


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## Laxwido (Nov 23, 2010)

It passes CCI edit check.  Based on the documentation,  I think I would bill both.  Make sure you use the syndesmosis disruption ICD-9 for the 27829, and the Trimal Fx ICD-9 for the 27822.   
Good Luck!


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## ggparker14 (Nov 23, 2010)

Thank you for your help.


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