10/01/2025    David Freedman, DPM

Revised Ankle Fracture

Revision of fibular fracture repair by you the
surgeon in the global 90-day period: This is
typically coded 27784 Open treatment of proximal
fibula or shaft fracture, with or without internal
or external fixation if this is a high fibular
fracture if it is really ankle and lower 1/3
fibula then it is CPT 27792-Open treatment of
distal fibular fracture (lateral malleolus), with
or without internal or external fixation.

You must add Modifier -78-Unplanned Return to the
Operating/Procedure Room by the Same Physician
Following Initial Procedure for a Related
Procedure During the Postoperative Period (but
revision may require modifier -22 for increased
complexity).

Repair of syndesmosis: This is coded CPT 27829-
Open treatment of distal tibiofibular joint
(syndesmosis) disruption, with or without internal
or external fixation again if distal portion was
treated. Modifier 78-Unplanned Return to the
Operating/Procedure Room by the Same Physician
Following Initial Procedure for a Related
Procedure During the Postoperative Period (but
revision may require modifier -22 for increased
complexity). L

Last, Removal of hardware, if this was the same
site you were operating on to do the revision then
it is hard to justify the removal as you are
operating in the same incision and same osseous
structure. Although no NCCI edits exist make sure
you document why this was distinct and separate
for the CPT 20680-removal of internal fixation
device, deep (e.g., buried wire, pin, screw, metal
band, nail, rod or plate. One would expect the
hardware removal is often performed in conjunction
with revision procedures.

This also would require Modifier 78-Unplanned
Return to the Operating/Procedure Room by the Same
Physician Following Initial Procedure for a
Related Procedure During the Postoperative Period
(but revision may require modifier -22 for
increased complexity).

David Freedman, DPM, Silver Spring, MD

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