Orthopedic Coding Alert

Question: For a patient diagnosed with status post open reduction internal fixation right ankle with the mortise disruption, our surgeon did an operative repair. There was no nonunion. It was apparently a fracture that had shifted.

The operative note reads as follows:

"The patient was taken to the operating room. The right leg was draped in the usual sterile fashion and antibiotics were administered. A straight lateral incision was made and the plate and hardware were removed without difficulty. There was bony consolidation noted at the distal tibio-fibular joint and this was resected with an osteome and with a rongeur. Soft tissue was released around the distal fibula. Care was taken to protect the peroneal tendons. The fracture site was idenified, an osteotome was inserted to complete the osteotomy. At this point tricortical allograft was inserted measuring approximately 6 or 7 mm in width. Stacked osteotomes were inserted to effect winding and distraction at the osteotomy site followed by an impaction of the tricortical allograft. Once complete fluoroscopy was used to confirm good position. It was noted that length was restored, the mortise was reduced. At this point the distal fragment was internally rotated to complete the reduction. A 7-hole Smith and Nephew plate was placed laterally and cortical screws distally. In addition, 2 syndesmotic screws were placed on either side of the allograft. At this point again fluoroscopy was used to confirm adequate reduction of the mortise and placement of hardware in both AP and lateral radiographs. The medial clear space was reduced to normal and the distal tibiofibular space was also within normal limits. The wound was irrigated. Closure was undertaken with 2-0 vicryl followed by staples on skin."

Minnesota Subscriber

Answer: You report code 27829 (Open treatment of distal tibiofibular joint [syndesmosis] disruption, includes internal fixation, when performed) for the fixation of the distal tibiofibular joint. You may report code 27707 (Osteotomy; fibula) for the fibular osteotomy. However, it is good to confirm with your surgeon if the patient had a malunion, in which case, you may report code 27726 (Repair of fibula nonunion and/or malunion with internal fixation) rather than 27707. For the ORIF of the distal fibula that your surgeon does, you report code 27792 (Open treatment of distal fibular fracture [lateral malleolus], includes internal fixation, when performed). You report 76000 (Fluoroscopy [separate procedure], up to 1 hour physician time, other than 71023 or 71034 [eg, cardiac fluoroscopy]).