Amy Posted 5 Year(s) ago
Please clarify CPT coding for removal and replacement with a shorter syndesmotic screw.
SuperCoder Posted 5 Year(s) ago
Skeletal deformities or injuries such as fractures may need prosthetic devices for repair. Skeletal fixation devices like pins, rods, or wires are used to join two skeletal parts and maintain their normal alignment while helping in faster healing. Once the defect has healed, the implants need to be removed. The implants could be located deep inside the body or nearer to the skin surface depending upon the anatomical location of the defect.
After administration of local anesthesia the implant site is prepped and draped. After adequate sterilization of the operative site, the previously made incision is re–opened. The incision is further extended through fascia and muscle to access the deep bone implant (rod, pins, wire, etc.). When the deeply inserted implant is identified, the pin or rod is unscrewed and dissected from surrounding tissue. Using the sharp forceps, the deep implant is pulled out. Once satisfactory removal of the deep implant is performed the incision is sutured in the layered fashion.
As supporting diagnoses, you may apply "encounter of removal of hardware" or "fitting / adjustment / removal of prosthesis / implant" types of ICD–9 codes, but no current injury or fracture codes are to be used as the current condition.
Clinical Scenario 1:
Question: Which surgical and anesthesia codes apply to pectus bar removal?
Answer: The correct surgical code is 20680 (Removal of implant; deep [e.g., buried wire, pin, screw, metal band, nail, rod or plate]). This crosses to many anesthesia codes, depending on the situation, but none of the codes specifies pectus bar removal. Because of this, some coders recommend reporting 00474 (Anesthesia for partial rib resection; radical procedures [e.g., pectus excavatum]) with modifier –52 (Reduced services).
This is the same code you report for the original procedure with 13 base units plus time. Because the removal is less intensive than the rod placement, reduce the base units because the procedure is not as invasive as the bar placement and includes a note in the Remarks box that the claim is for pectus bar removal.
Clinical Scenario 2:
Question: The physician performed two hardware removals on the same body part on the same day, but performed separate incisions. Can I bill 20680 twice?
Answer: No, you can't. According to the American Academy of Orthopaedic Surgeons, you should report 20680 (Removal of implant; deep [e.g., buried wire, pin, screw, metal band, nail, rod, or plate]) only once per site of hardware removal, regardless of how many screws the physician removed.
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