Syndesmotic screw removal with placement of Tightrope


Monmouth NewJersey Chapter
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We have a patient who had prior bimalleolar ankle ORIF with syndesmosis repair and placement of a syndesmotic screw. Patient is now allowed to be weight-bearing so the screw was removed and a Tightrope was placed. I am having a tough time finding the proper code(s) for this procedure. Tightrope placement is included in the ORIF & repair but neither of these procedures are being repeated. The op report is listed below. I have 20680 for the screw removal but would there be an additional code for the Tightrope placement?

Thank you and any help would be appreciated!

PREOPERATIVE DIAGNOSIS: Right ankle symptomatic hardware.

POSTOPERATIVE DIAGNOSIS: Right ankle symptomatic hardware.

PROCEDURE PERFORMED: Removal of syndesmotic screw with placement of TightRope



INDICATIONS FOR PROCEDURE: The patient is a xx-year-old male who previously sustained an ankle fracture with instability at the level of the syndesmosis. He underwent open reduction and internal fixation with placement of a syndesmotic screw. The patient was allowed to partially weight-bearing and recommended removal of hardware. At this point, it was also recommended because of the patient’s diabetes and poor healing capabilities to replace the syndesmotic screw with a second TightRope device. There was already one TightRope placed.

DESCRIPTION OF PROCEDURE: The patient was identified in the preoperative holding area, and the operative extremity was identified. He was then transferred to the operating room and moved onto the operating table with Anesthesia control and had orthopedics protecting all bony prominences. Prophylactic preop was given. A time-out procedure correctly identified the patient and operative procedure. Once this was done, the limb was prepped and draped in the usual fashion. No tourniquet was used. A #15 blade scalpel was used make incision directly over the syndesmotic screw. Once the screw was identified, it was removed uneventfully. At this point in time, the syndesmosis was maintained in a portion of reduction with ankle position and a TightRope was placed and tensioned without difficulty. The wound was then copiously irrigated with normal saline. Then, 2-0 Vicryl and 3-0 Vicryl were used to close the subcutaneous tissue and nylon was used for skin. Sterile dressing was placed. Sponge and needle counts were correct at the end of the procedure. There were no complications. The patient was transferred to the postanesthesia care unit neurovascularly intact without difficulty. The patient tolerated the procedure well.