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. 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).  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).