# Percutaneous fixation ankle Maisonneuve fracture



## AR2728 (May 29, 2014)

I'm so very lost on this procedure---I'm looking at an unlisted code.  Assistance would be very much appreciated!

Patient found to have posterior malleolus fracture with widening at the medial joint space and proximal fibula fracture

*Closed reduction and percutaneous screw placement. *
_After localization under fluoroscopy a stab incision was made laterally over the fibula and medially over the medial malleolus. A reduction tenaculum was used to close down the syndesmosis. At this point in time a 2.5 drill bit was used to drill a hole parallel with the joint space crossing all four cortices which were the fibula and tibia. X-rays showed appropriatedrill placement. A 50 mm 3.5 full threaded cortical screw was then placed across all four cortices with the reduction being held on the syndesmosis. The tenaculum was the removed. X-rays were taken and showed appropriate reduction of the syndesmosis and of the joint space. At this point in time the wounds were copiously irrigated with normal saline. Tourniquet was let down. There was no significant bleeding. 2-0 Vicryl suture was used to the subcutaneous tissue. 3-0 nylon suture was used to close the skin. Twenty cc of ? Marcaine plain was injected into the incision site. A sterile soft dressing of Xeroform, 4X4, Webril and a short leg posterior splint was placed_

I have looked at multiple options:  27829 for syndesmosis-I can't use this as this is open treatment and he had only small stab incision with closed/perc repair
27768 and 27781- clearly not what was performed since perc repair

Any suggestions at all?  I feel like my only option is an unlisted code.  Nothing clearly demonstrates what he performed here?  If unlisted, any suggestions for what procedure code to compare this to?


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## coderguy1939 (May 30, 2014)

Is the surgeon stating that the repair was done percutaneously?


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## AR2728 (Jun 3, 2014)

I've been out of the office.....Yes, physician says perfomed percutaneous placement of screw


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## coderguy1939 (Jun 3, 2014)

It sounds like the surgeon is only addressing the ankle dislocation and not the fracture.  Based on the information you've given, possibly 27842 Closed treatment of ankle dislocation requiring anesthesia, with or without percutaneous skeletal fixation.  Did the doctor do a reduction of the fracture?


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## AR2728 (Jun 4, 2014)

THANK YOU!! I didn't even consider that.  Re-reading the operative report that appears to be exactly what he did!  Your time and advice is very much appreciated!!


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