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Screw and Plate Removal

Nicole Posted Wed 11th of June, 2014 14:43:51 PM

Patient had a TLIF / Laminectomy

The doctor removed patients previous screws and an interspinous plate. He replaced the screws during the procedure.

Would this be considered the 20680 or the 22852. I get slightly confused when trying to figure this one out. What differentiates when the 22852/22855 is supposed to be used over the 20680.

Any clarification would be appreciated!

SuperCoder Answered Wed 11th of June, 2014 18:21:14 PM

If the surgeon removed the screws but didn't insert new ones, you have two coding choices depending on the original procedure. Code with 22852 (Removal of posterior segmental instrumentation) if the iliac screws were part of a previous lumbar-spinal fusion. If the iliac screws were for an old pelvic fracture, your most likely choice is 20680 (Removal of implant; deep [e.g., buried wire, pin, screw, metal band, nail, rod or plate]). Append modifier 52 (Reduced services) to the procedure code to indicate the surgeon didn't remove all instrumentation. If, however, the surgeon inserted new screws, report 22849 (Reinsertion of spinal fixation device). No modifiers or other codes are necessary.

Explanation: Surgeons sometimes use iliac screws during spinal fusion cases to anchor or attach plates or rods going up to the lumbar spine. CPT includes specific codes for spinal instrumentation insertion and removal and your example definitely involves deep hardware. Because of this, you would report 22852 for the case in question instead of 20680.

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