# bone substitute - hardware removal



## reneejosette (Mar 9, 2010)

Hi All,

My question is about the use of bone substitute after hardware removal. Since the doctor is using the substitute for a non-union of a subtalar joint, would a repair code along with the hardware removal code be appropriate??
 My doc is wanting to use the cpt 20900 for the application of the graft. I thought that code was for harvesting of grafts. 

Thanks for your help!

R


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## etenndixiechick (Mar 10, 2010)

Can you copy and paste your op note (minus identifiying patient and doctor names)?  Yes, the 20900 is for the harvesting of bone.


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## reneejosette (Mar 10, 2010)

etenndixiechick,

Thanks for taking the time to respond. The op note is below:

Pre-Op dx: Painful hardware, nonunion subtalar joint, left foot

Post-Op dx: same

Operative Procedure:    1.Removal of internal fixation, left foot
                                2. Application of bone graft, left subtalar joint, quantity large.

The patient was brought into the o.r. General anesthesia administered. After identification, she was placed prone, prepped, draped and tourniquet applied.

Attention was directed to the posterior plantar heel where a 1.5cm incision was made. The wound was carried down to the bone. Two screws were identified. One a 6.5 and the second an 8.0mm and they were removed with a screwdriver. The canals were irrigated with saline. Hydroset Bone Graft was then prepared, 5cc in quantity. It was inserted through an inserter directly into the subtalar joint under fluoroscopic guidance. Once completed, the wound was closed with deep closure with 3-0 vicryl and skin closure with 4-0 nylon. Tourniquet released. Vascular status was intact. EBL was negligible. Sterile dressing was applied. No complications were encountered.


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