# Avulsion Fragment of the Medial Malleolar



## bethh05 (Feb 10, 2011)

Post Op: Painful medial malleolar avulsion fragment, chronic

Procedure: 
A midline incision over the distal medial malleolus was made and dissection continued down to teh deltoid ligament. C-arm views were obtained noting the location of the frament. This was marked off on the skin with a marker. The deltoid ligament was split retracting the anterior and posterior fragment was thus encountered. Carefully, the fragment was removed circumferentially from its soft tissue attachments. This fragment was split leaving a smaller and more posterior piece. This too was carefully shelled out from around its soft tissue attachments. This was removed. The ankle was copiously irrigated.C-arm views noted that the malleolar fragment had been removed. The Deltoid ligament was repaired with #0 Vicryl stitches followed by washout ant hen the sub-q closure with 2-0 Vicryl. Steri-Strips were applied. 

Anyone have any ideas? The physicians office coded 27640 but I am not sure because the fragment was in the soft tissue or am I reading too much into this? Any help is GREATLY appreciated! I was considering maybe 27610 with 76000 for fluoro?


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## Jamie Dezenzo (Feb 11, 2011)

I don't see an arthrotomy made so I leaning towards 27640


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## bethh05 (Feb 14, 2011)

I am a little unclear about the arthrotomy, are there specific guidelines to coding an arthrotomy? This was the ankle which is a joint, does the incision have to go into the synovium to qualify as an arthrotomy. Sorry, any clarification is appreciated!


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