I would assume changing the position of the nail, but still using the same nail... the surgeon would have to remove it, drill again, and re-implant it. I would use the unlisted 27299 - cross-referencing the 27245.
(if it is during the post op period, don't forget the 78 modifier).
However if your surgeon is using a new nail, I would code the removal of the implant 20680 and the implant procedure 27245.
Even though the procedures sometimes change once a patient is on the operating table, your surgeon should know best what he 'plans' for the pt. Ask them to be more specific... it may guide you better. Have a good weekend!
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