Coding question

CPT 27829: Syndesmosis Fixation, Coded Right

The high ankle injury has one code regardless of implant, and one documentation habit that decides whether it gets paid next to the fibula.

By Michael MacKechnie, MD, CM, FRCSC, FABOS, FAAOS, orthopaedic surgeon. Reviewed August 2026; reflects the 2026 Physician Fee Schedule.
Direct answer
27829 is open treatment of a distal tibiofibular joint (syndesmosis) disruption with fixation: 8.58 work RVUs, 90 day global, and the same code whether you place screws or a suture button. Alongside a lateral malleolus ORIF, both are reportable when both were performed: 27792 plus 27829, supported by a note that describes the syndesmotic stress examination, the instability found, and the distinct fixation placed for it.

What the code describes

27829 is the open treatment of a disrupted distal tibiofibular syndesmosis with fixation. The implant does not change the code: two cortical screws, one quadricortical screw, or a suture button construct all report 27829. It carries 8.58 work RVUs and a 90 day global period, so the postoperative visits, including the hardware conversations, live inside it.

With a fibula fracture

The common real case is a Weber C or high Weber B ankle: you fix the fibula and then stress the syndesmosis. When it is unstable and you place distinct syndesmotic fixation, both procedures are reportable, 27792 for the lateral malleolus ORIF and 27829 for the syndesmosis. The note has to carry both: describe the syndesmotic stress examination under fluoroscopy, the instability you found, and the separate fixation you placed for it. A syndesmotic screw mentioned in passing inside a fibular plating paragraph is how the second code gets denied.

Language that carries it: "After fixation of the fibula, the syndesmosis was stressed under fluoroscopy with an external rotation and hook test, demonstrating frank diastasis. The syndesmosis was reduced with a clamp and fixed separately with a suture button construct across four cortices."

What it is not

An isolated ligamentous high ankle sprain treated without fixation is not 27829. Percutaneous or closed screw placement without an open approach belongs to closed treatment coding. And when the syndesmosis is stable on stress testing and nothing is placed, there is nothing to report; documenting the negative stress exam is still worth a sentence for the medical necessity of the fibular construct chosen.

Check it against your own note

Paste the operative note into the Op Note Assistant; it applies these pairings to what you actually documented and prices the work. Orthopaedic surgeons can start at the orthopaedics path.

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