# Removal of hardware with metatarsal defect



## bethh05 (Mar 2, 2009)

Post op reads Painful hardware with metatarsal defect, right foot, he lists the procedures performed as Hardware removal, proximal first metatarsal, right foot, with OsteoCure bone putty implantation. 

Op note:The incision was carried deep to the level of the plate and screws , and the scar tissue and periosteum were sharply incised and reflected from the plate and the screws. The screws and plate were removed without incident. The large medial defect was identified in the proximal first metatarsal. Then utilizing a curette and forceps, all fibrotic tissue was removed from the defect. The OsteoCure was then prepared according to label instructions and inserted into the defect found there to be flushed with medial aspect of the bone. The area was then closed with 3-0 Vicryl. 

The physician charged out 20680 and 28322. I would think that the defect was from the implants and 28322 cannot be charged for? Any help is greatly appreciated!!


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## mad_one80 (Mar 2, 2009)

the doctor DID repair the metarsal graft separately from the hardware removal so i think he is right...use both the codes but bill as 28322 and 20680-59 to defferentiate between the 2 services performed.  remeber to use a complication dx for your hardware removal!


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## mbort (Mar 2, 2009)

but was the hardware removal necessary in order to repair the metatarsal?


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## Jamie Dezenzo (Mar 3, 2009)

I would think the hardware removal would not be coded and had to be removed to address the defect. Any other thoughts?


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## mbort (Mar 3, 2009)

thats where I was going with my "food for thought" question


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