# Hardware removal 20670



## skorkfranks (Jul 22, 2009)

Can a Dr. bill for multiple units of hardware removal if 3 separate incisions were made to remove the hardware? Pt. underwent scaphoid excision and intercarpal fusion with multiple K-wires. He is billing 20670 x 3 with Mod 59 on last two. Since this is the wrist, wouldn't this be considered the same compartment? Thanks.


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## vikas.maheshwari (Jul 22, 2009)

As is often the case in coding, there is more than one right answer depending upon the specific circumstances involved. The narrative for 20670* states removal of implant; superficial, (e.g., buried wire, pin or rod) (separate procedure). Surely this terminology has led many coders to the conclusion that this code can be reported for each implant that is removed, but this is not always the case. 

An example would be when your surgeon is removing two k-wires from a patient's wrist. Although it may seem perfectly logical to report 20670 twice, do not do so, because both implants are in the same anatomic site. Under these circumstances, you would report 20670 only once.

On the other hand, if your surgeon is removing a pin from the left index and ring fingers, it is appropriate to report 20670 twice. This is so because the implants are in two different anatomic sites.

for further assistant mail me at


vikasm@eliresearch.com or vikashmaheshwari@gmail.com


Thanks

Vikas Maheshwari
MBA-HCS, CPC-H


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## Bella Cullen (Jul 22, 2009)

I agree with Vikas.


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## skorkfranks (Jul 23, 2009)

Thank you so much for your help. I thought that this was the case Judi


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## mbort (Jul 23, 2009)

CPT ASST June 2009 reads:

Removal of Deep or Superficial Bimalleolar Plate and Screws 
Code 20680 would be used to describe the removal of a plate (eg, periarticular plate, locking plate, or one-third tubular plate) and screws from the fibula in a healed bimalleolar ankle fracture. If deep buried medial malleolar screws are removed from the tibia's medial malleolus at the same session, use code 20680.  

If removing superficial screws from the fibular fracture, code 20670 should be reported. If superficial screws are removed from the tibia's medial malleolus at the same session, the procedure is reported using code 20670 with modifier 59 appended. 

Multiple use of code 20680 would be appropriate only when the hardware removal was performed for another fracture in a different anatomical site unrelated to the first fracture (eg, ankle and humerus). In these circumstances, modifier 59, Distinct procedural service, would be appended to subsequent uses of the code. For example, two different and noncontiguous implants are removed from two different bones or two different (noncontiguous) sites on the same bone using multiple incisions. Depending on whether the implants were superficial or deep, code 20680 may be reported twice or codes 20680 and 20670, Removal of implant; superficial (eg, buried wire, pin, or rod (separate procedure), may each be reported.


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## med-biller (Jul 28, 2009)

If this is done prior to a repair of malunion of the fracture, the removal of the implant would be inclusive to the repair code, correct?


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