# Hardware removal from same site as repair



## etld (Nov 3, 2011)

Can someone please answer this question for me.
Is removal of hardware payable when a surgeon removes the hardware through the same incision/same site to repair the non-union fracture?


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## nrichard (Nov 3, 2011)

That depends on several things, what codes are you talking about, or better can you post the op-note?


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## etld (Nov 3, 2011)

The provider is billing 26860 Arthrodesis, interphalangeal joint, with or without internal fixation; and 26320 Removal of implant from finger or hand. This is of the LT ring finger, with DIP joint fusion with screw and removal of hardware was from LT ring finger middle phalanx. Quote from op report, " A 1.6 mm K-wire was drilled at a 15degree angle across the middle phalanx exiting the dorsal proximal middle phalanx. An axial K-wire hole was placed in the distal phalanx and a small incision was made over the distal phalanx. I should also point out that when attempting to make the drill tunnel in the middle phalanx, screws were encountered. Therefore, the incision was extended proximally. The ulnar aspect of the middle phalanx was exposed and previously placed 1.3 mm lag screws were backed out of the middle phalanx. The fusion plate was then reduced. A 24 mm Acutrak fusion screw was then placed across the fusion plate. Excellent stability was noted."


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## maryanneheath (Nov 3, 2011)

etld said:


> The provider is billing 26860 Arthrodesis, interphalangeal joint, with or without internal fixation; and 26320 Removal of implant from finger or hand. This is of the LT ring finger, with DIP joint fusion with screw and removal of hardware was from LT ring finger middle phalanx. Quote from op report, " A 1.6 mm K-wire was drilled at a 15degree angle across the middle phalanx exiting the dorsal proximal middle phalanx. An axial K-wire hole was placed in the distal phalanx and a small incision was made over the distal phalanx. I should also point out that when attempting to make the drill tunnel in the middle phalanx, screws were encountered. Therefore, the incision was extended proximally. The ulnar aspect of the middle phalanx was exposed and previously placed 1.3 mm lag screws were backed out of the middle phalanx. The fusion plate was then reduced. A 24 mm Acutrak fusion screw was then placed across the fusion plate. Excellent stability was noted."



Just my opinion, but I would bill the 26860 for the arthrodesis, and bill 20680 for deep hardware removal, which is more appropriate for screw removal than the 26320, which I take to be an actual implant or prosthesis, such as Silastic.


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## etld (Nov 4, 2011)

But, is the removal of hardware payable when it is from the same site and incision as the non-union repair and new hardware is inserted?


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## campy1961 (Nov 7, 2011)

It all depends on the insurance carrier.  Some will accept the 20680 with a mod 59.


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