# IM Rod of Fibula?



## CJoy0724 (Feb 10, 2012)

Need some help on this one.  Patient had IM Nail of Tibial shaft  (27759) and IM Rod of Distal Fibula. I'm at a loss at how to code the fibula. Dr. is thinking 27792, but is that really accurate?  I see 27759 says "with or without fibular fracture" so does that mean it would not be billable?  Here is that section of the OP note:

"We then made an anterior incision over the knee and developed medial to the patellar ligament.  The proximal tibia was opened with a cannulated reamer.  We used a the Synthes EX tibial nail.  A ball-tipped guidewire was placed down across the fracture into
the distal fragment.  We then proceeded to ream proximally to 12.5 mm and
distally to 11 mm.  We then placed an antegrade Synthes EX tibial nail 11 x 420
mm.  We made sure that the fracture was adequately reduced including all
appropriate planes of orientation.  We placed medial and lateral distal locking
screws.  The fracture was then back tapped and impacted and then proximal static
locking screws x2 were placed.  We then turned our attention to the fibula.  A
small incision was made at the tip of the fibula.  Actually, it was a retrograde
rodding technique using Synthes flexible rods 2.5 mm x1.  Once the distal fibula
was opened, I did a retrograde rodding of the fibula.  We then bent the rod and
impacted it.  I chose not to do an open reduction and internal fixation because
I did not want to additionally devitalize the tissues, and the fracture was in
the metadiaphyseal portion and I thought it was amenable to rodding."

Any help would be greatly apprectiated!!!


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## MPopkin (Oct 9, 2014)

*Fibula Nail*

So my scenario is similar and I see there has been no response. The fibula was IM nailed and the tibia was only screwed. Should I simply use the Bimalleolar ORIF and add a 22 or code the bones separately and if so what would I use for the IM rodding of the fibula?


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