Question Trimalleolar Fx Question


Vero Beach, FL
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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?
I think might be okay. If you read the description of 27822 it's medial AND/OR lateral malleolus. So even though he already fixed the med. mall, he's still treating a trimall fracture and now doing the lateral. The "or" makes it work. Trimalleolar is more complicated. But, it does seem weird because why wouldn't it be 27822 for both, then...
Or, should it be broken down like you are thinking into 27766 first and then 27792 (with the other codes for the ex-fix, etc.)
I wonder if it should actually be 27822 for both stages with 58 on the second.
Did you check CPT Assistant? I don't know that I have seen this scenario where they actually did an ORIF of the med. mall first. Usually it's ex-fix w/ closed reduction and then definitive later. Did he for sure do ORIF of the med mall first?