# Syndesmotic injury,ankle



## ebarnett (Nov 12, 2008)

My Podiatrist did a Percutaneous syndesmotic screw placement on a patient and he coded 27829, which I know is wrong.  I'm thinking  that I'm going to have to use an unlisted code, 27899.  I need another opinion please. Here's the meat of the op note:

Utilizing an Esmarch bandage, the right foot, ankle and lower leg region was exsanguinated and the pneumatic thigh tourniquet raised to 350 mmHg. At this point in time, attention was directed to the lateral aspect of the right ankle joint where the anterior and posterior portions of the fibula were drawn out, and then utilizing a C-arm to visualize appropriate syndesmotic screw placement, a 1 cm proximal to distal linear incision was made along the fibular shaft. Dissection was carried down to the fibular bone. Utilizing the guidewire for a 4.0 mm Metasurg partially threaded screw was inserted through the fibula through the syndesmosis and into the tibia under C-arm guidance. Lateral radiograph confirmed good placement of the guidewire. Over-drilling of the guidewire was performed followed by countersinking and measuring and insertion of a 4.0 mm partially threaded Metasurg screw.  Final C-arm radiographs confirmed good placement of the screw.

Elaine


----------



## mbort (Nov 12, 2008)

why do you feel that the 27829 is not correct?

This does not appear to be percutaneous in nature.  He states he made an incision with dissection.


----------



## ebarnett (Nov 12, 2008)

*syndesmotic injury,ankle*

I was thinking of it as a stab incision and his wording of percutaneous as the procedure performed.  Since he dissected down to the bone is that what makes it open treatment?  Thanks for you help.


----------



## mbort (Nov 12, 2008)

yes, this case was clearly open in nature. (be sure to read the body, not just the headers)


----------



## CJoy0724 (Mar 17, 2011)

Just curious on this, if it truly was percutaneous, how would you code it? I have one that reads as follows:

A large bone reduction clamp was used to affix the fibula to the tibia, closing
the medial clear space.  This was then stabilized with small stab wounds, and
the hole drilled for 3.5 cortical screws.  Tricortical screw fixation was
obtained from the fibula to the tibia with two screw fixation.

I was thinking 27842, but this truly was a a syndesmosis disruption, not an ankle dislocation...

Any ideas?


----------

