# Diagnosis for Hardware Removal



## esimonsen (Jan 18, 2017)

Hi, I have seen this question asked a while ago, but the answers didn't quite make sense.

When our docs do 20680 hardware removal for painful hardware (or loose hardware/ arthrodesis / broken hardware etc), how does the DX coding work?

I am inclined to use a T code like T84.84xA Pain due to internal orthopedic prosthetic devices, implants and grafts, initial encounter 

What I can't figure out conclusively is, do I also have to list a second code for the original fracture with a D?  Or is this unnecessary.  I have seen it be billed and paid both ways but I am trying to figure out what the correct guideline is.

I also see Z47.2 Removal of internal fixation device, but then states for aftercare of healing fracture to use the fracture code with a D..?  

Any good guidelines, resources, tips for me?


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## Orthocoderpgu (Jan 18, 2017)

*Use Z or T codes only*

Look up Z47.2. This is the code to be used when there are no complications and it's time for the hardware to be removed since the fracture has healed.

If you look at the "Excludes 1" which is a hard exclude, meaning that you can't code it with Z47.2 it lists removal of external fixation, infection or mechanical complication.

I would only use Z47.2 if there are no complications at all and the hardware is being removed simply because "it's time".

If the hardware causes pain, fails, displaces, backs-out, or becomes infected, use the appropriate T code only for that specific complication and not use the Z47.2 with it.


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## martnel (Jan 18, 2017)

I am coding T84.84AX or whatever the problem is, as primary, and the original fracture/injury, with a "S" as 7th digit.   https://www.aapc.com/blog/27096-initial-subsequent-sequela-encounter/


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## mitchellde (Jan 18, 2017)

The Z47.2 code is an aftercare code and you will not use that if this is aftercare of an injury.  In addition you will not code the injury with an S because this is not a residual of the injury, this is something new caused by the presence of the hardware.  so the appropriate approach is the complication code with the A as the extender.  Painful hardware is not a complication of the injury that is why it is not coded as sequel.  This is a new issue that is coded as a complication.  When the patient returns to have stiches removed or follow up or rehab due the hardware removal you will use the complication T code for the painful hardware and append the 7th character D.
The Z47.2 would be used if the hardware was not indicated as painful and had not been placed due to an injury.


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## dvanevans@gmail.com (Jul 15, 2019)

I work in a SNF and am trying to code aftercare for a hip replacement due to broken hardware. Should I use Z47.32 "Aftercare following surgery for explanation of joint prosthesis( staged procedure) or the complication code?


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