# Tibial/fibular joint fixation help



## mindyanna (Jul 14, 2011)

I need assistance on the following operative report.  The physician wants to use code 27871 but I don't think his description of what he did fits that code.  Here is that portion of the operative report:

"Attention was then given to the distal tibial/fibular joint.  A 1.5-mm wire was inserted on the distal fibula and driven through the distal fibula and across the distal tibia and out the anteromedial surface of the distal tibia.  The wire was withdrawn on the medial side until the lateral portion of the wire was flush with the lateral cortex of the distal fibula.  At this point a small stab incision was created anteromedially and the wire was measured, over-drilled, and a 4.5-mm cortical screw was inserted through the distal tibia, into the distal fibula, completing the distal tibial/fibular joint fixation.  This wound was closed with 3-0 Vicryl and 4-0 Monocryl."

In looking at the description of code 27871 in the Coders Desk Reference (it's the only book I have) it seems there is a lot more involved when doing a fusion.  He is just temporarily fusing the bones together.  What do you think?  Would code 27829 better fit to what he did?  

I would greatly appreciate anyone's insight and suggestions.

Thanks


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## PLAIDMAN (Jul 14, 2011)

What was the dx?  Why is he doing the surgery?

I don't think you can "temporarily" fuse.  Based on what you wrote it does not sound like an arthrodesis.


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## mindyanna (Jul 15, 2011)

PLAIDMAN said:


> What was the dx?  Why is he doing the surgery?
> 
> I don't think you can "temporarily" fuse.  Based on what you wrote it does not sound like an arthrodesis.


The diagnosis codes he's using are:736.41 (genu valgus), 736.89 (tibial torsion), 755.30 (leg length descrepancy), 736.72 (equinus contracture)  The other procedures he's doing are 
1. Tibial/fibular osteoplasty (27715)
2. tibia/foot faylor spatial frame enternal fixation (20696)
3. gastrocsoleus recession (27687)
4. tarsal tunnel decompression (28035)
5. distal tibia/fibula joint screw fixation (this is the one I'm questioning)
6. gastrocnemius muscle botulinum toxin (64614)

Does that help?  When I spoke to the doctor about this he said that he wasn't repairing a syndemosis so he doesn't like the 27829 code but I'm not so sure about the 27871 code either; as I said before, what he did doesn't fit the description of a fusion.


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## PLAIDMAN (Jul 15, 2011)

*Anyone else helpout*

It still sounds like he did 27829- the code says "treatment" of a "disruption" whether the disruption was an acute dislocation or an other aquired deformity that disprupted the joint.

It definately does not meet 27871, my description of this includes removing the talus, cutting the calcaneus so it meets flat with the tibia, so they will fuse.

Sorry, I am still leaning towards 27829... I guess i am still a bit confused as to why specifically he put the screw in syndesmosis if he says it was not for a disruption?  If he did to prevent disruption because of other proced. he did, maybe i would put a "22" on the other proced. with cover letter explaining this extra work.  I would be hesitant to use unlisted because there is a cpt code for what he did.  You CAN use this code for more than a dislocation, I have had it approved on just an instability dx.

ANYONE ELSE HAVE SOME THOUGHTS?


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## mindyanna (Jul 21, 2011)

PLAIDMAN said:


> It still sounds like he did 27829- the code says "treatment" of a "disruption" whether the disruption was an acute dislocation or an other aquired deformity that disprupted the joint.
> 
> It definately does not meet 27871, my description of this includes removing the talus, cutting the calcaneus so it meets flat with the tibia, so they will fuse.
> 
> ...


Plaidman, thank you for your assistance and your thoughts.  I am in agreement with you however if anyone else has anything different they would like to add that would be greatly appreciated too.  I'm kind of in a jam and need to get this coded and out the door.  Thanks!


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## Treetoad (Jul 23, 2011)

I agree with 27829.


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