Initial surgery was 27829 with placement of two syndesmotic screws as fixation. Four months later, the fixation must be removed, and a permanent fixation put in place of the screws. I know, the 20680, but what about the replacement of the new fixator? I can't bill 27829 again (?). The area is still unstable, and the tightrope fixator will stay in place allowing for movement and stabilization. If I can't bill the 27829 again, is there a code for placement of fixation?