Camille Posted Thu 10th of October, 2019 15:54:42 PM
Procedure indications: ...a 36-year-old who underwent previous treatment of a scaphoid fracture here. His CT scan shows partial healing and there is a prominence of the screw dorsally. He has been counseled regarding the management options and is brought back for removal of the hardware and exchange of the screw. Given the partial healing, we need to maintain fixation. Procedure description: The procedure began with incision in the distal limb over the thenar area, sharp dissection with a #15 blade, blunt dissection with Freer elevator and tenotomy scissors down to the level of the scaphoid where the implant was identified. A guidewire was placed through the middle implant, then withdrawn. It was then measured a size 24, exchanged for a size 20, and then seated here with compression going to a standard screw. We felt that this provided good fixation and also was then shy of the dorsal cortex. Alignment was satisfactory in all planes and taking it through an arc of motion here with the underlying fluoro and also with sequential imaging. Satisfied that its position was satisfactory, thus the hardware removal of deep implant, wrist, was completed as was the internal fixation of the scaphoid fracture. THE FEE TICKET: CPT/ICD-10: 20680/T84.498A and 25628/S62.021G Question: Does the Procedure Description adequately describe the work of 25628 or is this a Hardware Exchange only? If Hardware Exchange only, what CPT can i code (along with CPT 20680) in order to bill and receive payment for the new implant (for this ASC claim)? Thank you, kindly!
SuperCoder Answered Fri 11th of October, 2019 04:20:58 AM
Submitted CPT codes and ICD-10 CM codes look appropriate. Please bill CPT code 20680 for removal of implant from scaphoid bone along with CPT code 25628 for internal fixation of scaphoid bone with new implant. There is no bundling issue between these two codes as per NCCI edits for Q4, 2019 and hence both codes can be billed together.
Camille Posted Fri 11th of October, 2019 12:44:14 PM
I have two questions if you will: Will you please tell me the rationale for why 20680 seems to bundle with some but not all ORIFs? And will you please tell me if there is a specific criteria you looked for to determine this was more than an implant exchange? Thanks very much for your time!
SuperCoder Answered Mon 14th of October, 2019 04:39:33 AM
All CPT code edits (bundling/unbundling) results are based on NCCI guidelines set forth by CMS. As per NCCI for 2019, there are CPT codes (20670 and 20680) for removal of internal fixation devices (e.g., pin, rod). These codes are not separately reportable if the removal is performed as a necessary integral component of another procedure. For example, if revision of an open fracture repair for nonunion or malunion of bone requires removal of a previously inserted pin, CPT code 20670 or 20680 is not separately reportable. Similarly, if a superficial or deep implant (e.g., buried wire, pin, rod) requires surgical removal (CPT codes 20670 and 20680), it is not separately reportable if it is performed as an integral part of another procedure. CPT code 20670 or 20680 (removal of implant) shall not be reported for the removal of wire sutures during cardiac reoperation procedures or sternal procedures (e.g., debridement, resection, closure of median sternotomy separation).
Also, there is no single specific CPT code for implant exchange (replacement). Therefore, we had to take separate codes, one for removal of implant and other for insertion of implant.
Hope provided information would be helpful.