Wiki Bundling issue with CPT 27829 and 27781

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klienhart

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Hi,

We recently had an issue with a provider wanting to bill 27829 (Open treatment of distal tibiofibular joint [syndesmosis] disruption, includes internal fixation, when performed) and 27781 (Closed treatment of proximal fibula or shaft fracture; with manipulation). The codes bundle by both CCI edits and AAOS. My question is why? The syndesmosis disruption is in the ankle area, while the fibula fracture is at the proximal end. Has anyone ever come across this? The provider is asking why they bundle. TIA!!
 
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My guess is that this stems from two coding guidelines. Smaller procedures performed in the same area as larger ones bundle, and if a cast/splint treats more than one fracture/dislocation only one fracture or dislocation is billable as the others seem to come along for the ride. I have seen similar situations such as this. I think the reason for the edit is that both injuries stem from the same injury. The syndesmosis is a major repair and a cast will be applied. Moving the fibula into place before the cast is applied is not enough "work" to justify a separate procedure. I'm not saying that I agree with this, just as an experienced foot and ankle coder this is my thoughts on why they would bundle these two procedures.
 
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Orthocoderpgu said:
My guess is that this stems from two coding guidelines. Smaller procedures performed in the same area as larger ones bundle, and if a cast/splint treats more than one fracture/dislocation only one fracture or dislocation is billable as the others seem to come along for the ride. I have seen similar situations such as this. I think the reason for the edit is that both injuries stem from the same injury. The syndesmosis is a major repair and a cast will be applied. Moving the fibula into place before the cast is applied is not enough "work" to justify a separate procedure. I'm not saying that I agree with this, just as an experienced foot and ankle coder this is my thoughts on why they would bundle these two procedures.
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Thank you for the explanation, as it does make sense to me.
 
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I've run into this a couple times and think it may stem from a specific fracture type: the Maisonneuve Fracture. This fracture type is a proximal fibula fracture with syndesmotic injury. From what I've seen, treatment for this injury is directed at stabilizing the ankle disruption. I think this could be a possible reason for the CCI edit.
 
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