# CPT 20680 & 26530 together



## sateeshtv (Jun 15, 2016)

Dear All:

Can we reports CPTs 20680(Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate) & 26530(Arthroplasty, metacarpophalangeal joint; each joint) together? I can't see any CCI edits, but there is a guideline given below in policy manual

" There are CPT codes (20670 and 20680) for removal of internal fixation devices (e.g., pin, rod). These codes are not separately reportable if the removal is performed as a necessary integral component of another procedure. For example, if revision of an open fracture repair for nonunion or malunion of bone requires removal of a previously inserted pin, CPT code 20670 or 20680 is not separately reportable."

Is it applicable with CPT 26530? CPT assitant November 2015 page 10a says CPT 20680 can be reported with screw replacement code.Kindly help

Thanking you,


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## CodingKing (Jun 15, 2016)

NCCI doesn't cover every single instance of improper coding. So lack of NCCI edit does not necessarily mean you can code both in the same OP session


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## dalanicks@aol.com (Jun 15, 2016)

I just looked these two codes are okay to be billed together


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## CodingKing (Jun 15, 2016)

The removal of implant codes do have the "Separate Procedure" wording. There is a general statement in the NCCI manual:

CHAPTER I
GENERAL CORRECT CODING POLICIES
FOR NATIONAL CORRECT CODING INITIATIVE POLICY MANUAL
FOR MEDICARE SERVICES



> J. CPT “Separate Procedure” Definition
> If a CPT code descriptor includes the term “separate procedure”, the CPT code may not be reported separately with a related procedure. *CMS interprets this designation to prohibit the separate reporting of a “separate procedure” when performed with another procedure in an anatomically related region often through the same skin incision, orifice, or surgical approach.*


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## sateeshtv (Jun 16, 2016)

Thanks for kind feedback.I agree that removal of screw will be part of arthroplasty. Confusion arose , since CPT assitant is telling differently in latest article for CPT 20680


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## cliff.chen89 (Aug 7, 2019)

CodingKing said:


> NCCI doesn't cover every single instance of improper coding. So lack of NCCI edit does not necessarily mean you can code both in the same OP session



Hi CodingKing, then what else is there besides NCCI, (separate procedure), and Medicare's NCCI policy manual that shows which codes are bundled are not bundled together? Is there another list out there like the NCCI edits?

I'm trying to get some sort of documentation to show my provider since they want to bill things like:
27236 with 27062(-51)
27792 with 27829(-51) or
27822 with 27829(-51)
25650 with 25290
and while the advice on these forums has said that these shouldn't necessarily be billed unless there was a separate incision or different anatomic location, since NCCI show that these code pairs have no conflicts that they should be billed together and my provider won't accept the answers on these forums and wants an official article/document.


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## lisagbishop (Aug 8, 2019)

I also have two surgeries I was wondering about.  One in which he removed a plate from the ulna (20680), did a fusion (25810) and then placed another plate.   This was for arthritis.
In the other he shortened the ulna to relieve an impingement (25390) and placed a new plate with 7 screws. 
He is questioning if there is a better code to use than 20680 and I don't see one offhand.
Thanks,


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