# Removal of hardware-Revisited



## dhuttie (Oct 23, 2013)

Removal of superficial screws, medial malleolus (20670) and
Removal of Deep plate and screws, lateral malleolus (20680)
Done through separate incisions - different bones -- so can this be billed as 20680 with 20670-59?

I keep looking an article that says this about a BBFF and I guess I am comparing this to that. It says: "
*Code 20680 is reported once for each bone when removing internal fixation of healing fractures of "both bones" (radius and ulna) of the forearm when each bone is treated with separate plates and screws. If the plate and screw system is removed from the ulna at the same session as the radius, code 20680 with modifier 59 appended is reported.* These plates may be described by size (eg, small fragment system or small fragment plate) or by a trademark or type (eg, locking plate, periarticular plate, or polyaxial locking plate). Alternatively, the hardware may be described by the name of the manufacturer.  Each plate and screw system removal procedure would be reported separately using code 20680 with modifier 59 appended to denote distinct procedural services (eg, different site or separate incision) performed on the same day by the same physician. Removal of any and all screws used for each fixation system (ie, one plate and its associated screws) is part of the service of the plate removal."

I know one cannot bill for removal of individual screw that is removed via a separate incision on the same bone - so thoughts?  Am I correct to bill the above surgery as stated or is this just "creative billing"?


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## OCD_coder (Oct 23, 2013)

I would be very cautious about billing a 20670 without reviewing more of the Op Report.  The malleolus is the same bone, you are describing the different sides of the same bone; which would make me review the documentation carefully for the type of closure and whether or not the provider visualized the implant for the 20670.  Was the closure for the 20670 simple or repaired in layers?

I was taught by Mary LeGrand of Zupko and Associates that even when there are two incisions when hardware removal is at the same level on the same bone the hardware mechanism is considered 1 unit and the 20680 would only be billed.  The ankel area is not unsual to have two incision due to the angle of the bones in that area.


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## nyyankees (Oct 24, 2013)

dhuttie said:


> Removal of superficial screws, medial malleolus (20670) and
> Removal of Deep plate and screws, lateral malleolus (20680)
> Done through separate incisions - different bones -- so can this be billed as 20680 with 20670-59?
> 
> ...



We use 20680 once for each fracture. If patient had 1 fracture of the ankle the 20670, even though thru a separate incision, would be inclusive.


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## KMCFADYEN (Oct 25, 2013)

I would bill only 20680


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