Syndesmosis Repair

Question:

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.

Answer:

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.