# Bimalleolar fracture



## slc112071 (Oct 23, 2014)

Could someone please help with this one and give me your opinion?

PREOPERATIVE DIAGNOSIS:  Left bimalleolar fracture.
POSTOPERATIVE DIAGNOSIS:  Left bimalleolar fracture.
OPERATION PERFORMED:  Open reduction and internal fixation with syndesmosis
screws, left bimalleolar fracture.
ANESTHESIA:  General.
SURGICAL FINDINGS:  As anticipated, the fracture was reducible and with
closure of the syndesmosis.  The medial side was closed.
REPORT OF OPERATION:  The patient was brought to the operating suite and after
satisfactory general anesthetic had been administered, tourniquet was applied
to the left thigh.  The left splint was removed.  The left leg, thigh and foot
were prepped and draped in usual sterile fashion.  After gravity
exsanguination, tourniquet was elevated.  A 10 cm incision was made over the
lateral side, taken down through hemorrhagic subcutaneous tissue down to the fibula.  The periosteum and hematoma were then irrigated and removed using the PICC so that the fracture could be brought into reduced position and held with a bone reduction forceps.  A lateral plate was selected.  Two screws placed distally, one proximally and then the syndesmosis and fluoroscopic images were taken with stress evaluation.  Under fluoroscopic control, two syndesmosis screws were then placed.  A proximal screw was placed.  Final fluoroscopic images demonstrated stabilization of the ankle and no subluxation, anterior, posterior.  Thorough irrigation was done.  The subcutaneous tissues were closed with interrupted 2-0.  Skin was closed with staples.  Marcaine 0.5% plain was injected along the skin edge for postoperative analgesia.  Sterile dressing with a bulky bootstrap and posterior splint was then applied.


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## lekishabryant@rocketmail.com (Oct 23, 2014)

It looks like the physician only treated the lateral malleolus by an open method and the medial side was treated closed. I would query the physician to find out if there was so sort of widening or subluxation of the syndesmosis before he applied the screws.  Because from I'm reading it looks like just that but we can not infer as coders so it must be presented in writing.  If so, maybe the dislocation/subluxation can be coded as well.

Lekisha Bryant, CPC, COSC


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## somountain@aol.com (Oct 28, 2014)

*ORIF Bimalleolar FX*

#27804  is what our office coder would use.  Also, I had this exact surgery while traveling and this is the only code they used, as well.  I'm interested in this too !


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## lekishabryant@rocketmail.com (Oct 29, 2014)

The note says that the physician only treated the lateral side w/ORIF and the medial side was treated in a closed manner.  The description for 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.  

Lekisha Bryant, CPC, COSC


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