June 22, 2023
I coded a case for one of our surgeons where he did an ORIF of a distal tibia/fibula fracture (Pilon) and syndesmosis repair and documented a separate diagnosis to support each procedure. I recommended CPT code 27828 (Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of both tibia and fibula) and CPT code 27829 (Open treatment of distal tibiofibular joint (syndesmosis) disruption, includes internal fixation, when performed). My surgeon stated he was recently advised that the 2 codes were not reportable together and would not let me submit.
The patient is not Medicare and payor does not follow NCCI edits.
Thank you for the thoroughness of your question.
You were correct! Repair of the syndesmosis is not inclusive to the Pilon fracture (27828). Perhaps you can do a corrected claim if it is not too late.
The repair is performed for different medical necessity than the ORIF of the fractures; not all Pilon fractures will have syndesmotic instability.
*This response is based on the best information available as of 06/22/23.