A surgeon in our practice fixed a trimalleolar fracture in two stages. The first stage he applied an external fixation device and performed open treatment of the medial malleolus fracture. He coded it as 27766 and 20692. Eight days later the following procedures were performed: 1. removal of external fixator 2. syndesmotic reduction and fixation 3. distal fibula reduction with intramedullary nail. He wants to bill the following codes: 20694, 27829 and 27822. He already fixed the medial malleolus so billing ORIF of a trimal fracture does not seem appropriate. Thoughts?