Is it commonplace to bill 20690 (uniplanar external fixator) and 27825 (closed manip tx pilon) at the initial surgery, and at the time of the definitive surgery, to bill 27827 (open tx pilon) with a 58 modifier.

The physicians thought is that the closed manipulation is a separate procedure from the external fixator, done as a separate and specific maneuver during surgery, and is a necessary step in temporizing an injury. Therefore, the closed manipulation should be coded separately, and is not inherently bundled into the external fixator code. I just need clarification and a reference, if possible.

This is not a case where fixator is applied and closed treatment did not repair the fracture, and the decision was made to return to the OR for open treatment which would be billed with a -78 modifier.

Questions I have are:
1) Is the physician meeting the global requirements of the closed procedure (number of visits required, etc.)
2) Is it acceptable to bill a patient for 2 related procedures at full reimbursement for the same fracture?