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painful screw removal from metatarsal 20680 Keller procedure and 28292

Tanesha Posted Mon 30th of March, 2020 22:04:37 PM
Is it appropriate to code the removal of screws if other procedures are performed in the same area? The pt. had a failed Austin bunionectomy. Now Keller and IF removal. Excerpt: Attention was then drawn to the dorsomedial aspect of the patient's right first metatarsophalangeal joint, where a large scar from her previous surgeries was noted. A #15 blade was then used to make an approximately 6 cm linear skin incision just medially to her existing scars. A second #15 blade was then used to deepen this incision to expose the extensor tendons which were then retracted laterally out of the way. The capsule was then incised and reflected back to expose the titanium Stryker screws. It was immediately noted that the two failed screws were loose, but the Chevron osteotomy performed prior appeared to be healed. Both of the screws were then removed and sent to pathology. Next, a sagittal saw was then used to make an osteotomy in the frontal plane from dorsal to plantar at the MPJ level at the base of the proximal hallux to complete the Keller procedure. The frontal plane osteotomy was completed, and the base of the proximal hallux was then removed to complete the Keller procedure.
SuperCoder Answered Tue 31st of March, 2020 07:44:46 AM

Hi Tanesha,


Thanks for your question.


Since the removal of screws is done via the same incision, it is inappropriate to report removal of screws separately with other procedure performed at the same site.


Moreover, the current procedure is a revision of the previous failed procedure. You won’t report 20680 (Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate) for the screw removal, because the revision is paid as a full value repair code and therefore includes the cost of removing the previous instrumentation.


Some payers may pay this separately. So please contact the payer before billing.


Please feel free to write if you have any question.



Tanesha Posted Tue 31st of March, 2020 10:55:47 AM
Thank you for responding. I didn't think it was appropriate, but there is a CPT assistant regarding reporting removal fixation screws during revision arthroscopic anterior cruciate ligament reconstruction. Although, another surgeon performed the prior procedure, it seems we still wouldn't report removal, but below states otherwise. Also, since it was reinjured, maybe, that's the catch. CPT Assistant, November 2016 Page: 9 Category: Frequently Asked Questions Frequently Asked Questions: Surgery: Musculoskeletal System Question: Our surgeon performed a revision arthroscopic anterior cruciate ligament reconstruction. The patient previously had an arthroscopic anterior cruciate ligament reconstruction performed by another surgeon and sustained another injury that ruptured the graft. As part of the revision procedure, our surgeon removed the graft and fixation screws that were implanted by the other surgeon. In addition to reporting code 29888, Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction, for the revision reconstruction, is it appropriate to report code 20680, Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate), for removal of the screws? Answer: Yes, code 20680 may be separately reported for removal of the screws in addition to code 29888.
SuperCoder Answered Wed 01st of April, 2020 08:55:17 AM

Yes, this is correct. The following reasons justify the use of code for hardware removal in the scenario provided above:


  1. The previous procedure was performed by a different physician.
  2. There is a fresh diagnosis i.e. new injury.


This may be considered as a new procedure. There is no CCI edit with 20680. Hence removal of hardware may be reported separately.


In earlier question, the procedure was a revision of the previous failed procedure. So, in that case, 20680 should not be reported separately. 


Hope this helps.



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