Open treatment of a distal tibiofibular joint (syndesmosis) disruption, including internal fixation when performed.

Verified May 8, 2026 · 5 sources ↓

Medicare: $673.03
Total RVUs: 20.15
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAOSAAPC

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 5 cited references ↓

Operative note must identify the specific mechanism and extent of syndesmotic disruption (e.g., complete vs. partial tear, associated Weber C vs. high fibula fracture)
Document the fixation method by name: syndesmotic screw, suture-button (e.g., TightRope), or other construct — include size and number of screws if applicable
Confirm open approach is documented; percutaneous or arthroscopic-assisted techniques require separate code consideration
Record intraoperative fluoroscopic confirmation of reduction and hardware position — note whether fluoroscopy was integral to the syndesmosis repair itself
Document any associated fractures treated at the same session (fibula, posterior malleolus) and the separate operative steps taken for each
ICD-10 diagnosis must support syndesmotic instability or disruption — codes for simple ankle sprain are insufficient to justify open fixation

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 27829 covers open surgical repair of a disrupted distal tibiofibular syndesmosis — the ligamentous complex that binds the tibia and fibula just above the ankle. This is not a routine ankle fracture code; it specifically addresses syndesmotic instability that requires direct visualization and stabilization, typically with a syndesmotic screw, suture-button construct, or similar internal fixation device. The 90-day global period means that all routine post-op care through day 90 — follow-up visits, hardware monitoring, wound checks — is bundled. Any E/M service unrelated to syndesmosis recovery during that window requires modifier 24.

When performed alongside fibula ORIF (e.g., 27792) on the same day, list 27829 as the primary code only if it carries higher RVUs; otherwise, sequence correctly and append modifier 51 to the lower-value code. Fluoroscopic guidance used intraoperatively to confirm screw placement across the syndesmosis is generally bundled and not separately reportable per NCCI policy. If imaging is performed as a distinct, separately identifiable service for a different procedure at the same encounter, use modifier 59 or XS with appropriate documentation.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.58
Practice expense RVU	9.94
Malpractice RVU	1.63
Total RVU	20.15
Medicare national rate	$673.03
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$673.03
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,876.77

Common denial reasons

The recurring reasons claims for CPT 27829 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Diagnosis code does not support open syndesmotic repair — payers flag claims where ICD-10 maps to ligament sprain rather than frank disruption or dislocation
Unbundling denial when 27829 is billed with fibula ORIF without proper modifier 51 sequencing or documentation of distinct surgical steps
Global period violation: post-op E/M visits billed without modifier 24, triggering automatic denial within the 90-day window
Missing or vague operative documentation — notes that say 'syndesmosis repaired' without specifying approach, fixation type, or reduction confirmation
Bilateral or site modifier absent when procedure is reported for a specific extremity in payer systems requiring LT or RT

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Can 27829 be billed on the same day as fibula ORIF (27792)?

Yes, if both procedures are performed and distinctly documented. Sequence the higher-RVU code first and append modifier 51 to the secondary procedure. The operative note must describe separate surgical steps for each — a single sentence covering both is an audit target.

02Is fluoroscopy separately billable with 27829?

No. Per NCCI policy, fluoroscopic guidance used to confirm syndesmotic screw placement during the repair is bundled into the procedure. Do not report a fluoroscopy code for guidance integral to 27829.

03What modifier is needed for a post-op visit during the 90-day global if it's unrelated to the syndesmosis repair?

Modifier 24 appended to the E/M code. Document clearly in the visit note that the encounter addresses a condition separate from syndesmosis recovery — same diagnosis is not sufficient justification alone, but it doesn't automatically disqualify the modifier either.

04Does 27829 cover suture-button (TightRope) constructs, or only screw fixation?

27829 covers open treatment of syndesmotic disruption with internal fixation when performed — the construct type (screw, suture-button, or combination) does not change the CPT code. Document the device used; implant coding is handled separately per facility and payer policy.

05If the same surgeon returns to the OR within the global period to remove a syndesmotic screw, which modifier applies?

Modifier 58 if the hardware removal was planned or staged. Modifier 78 if the return was unplanned and related to a complication of the original repair. Do not use modifier 79 — that is for unrelated procedures only.

06Should LT or RT modifiers be appended to 27829?

Yes, when billing in systems that require site identification — most Medicare MACs and commercial payers expect LT or RT on unilateral ankle procedures. ASC facilities should report two separate claim lines with LT and RT if billing bilaterally, rather than modifier 50.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the syndesmosis fixation approach (open vs. percutaneous-assisted), fixation construct name and configuration, intraoperative reduction confirmation method, and any concurrent fracture repairs with their distinct surgical steps. This prevents the most common audit flag for 27829: operative notes that describe the outcome ('syndesmosis reduced and fixed') without documenting the distinct procedural elements required to justify the code and defend against bundling edits when co-procedures are billed.

See how Mira captures CPT 27829 documentation