# Hardware removal toes



## peporter (Oct 31, 2008)

I know with hardware removal it doesn't matter how many screws are removed but what about location. If it is removed from the second through fifth toes do I code it four times? I am thinking yes, since they are separate sites but wanted your imput on the subject. Thanks, Paula


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## Bella Cullen (Oct 31, 2008)

Hello, 
I think if dr does separate incisions to remove them in each location I don't see why you couldn't bill it multiple times. So I would say bill multiple times. 
Happy Halloween!!


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## mbort (Oct 31, 2008)

this can be a touchy one. what was the original purpose/reason/dx for all of these screws in each individual toe?


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## magnolia1 (Oct 31, 2008)

Paula,

I don't find any information that contradicts coding 20670 or 20680 for multiple sites. As a matter of fact, refer to the website (it addresses your situation).


http://www.beckersasc.com/ambulator...four-common-orthopedic-coding-challenges.html


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## mbort (Oct 31, 2008)

on the contrary, the AAOS (American Academy of Orthopedic Surgeons, AAOS.com) states the following which can alter the coding:

Hardware removal 

Q: The patient had a bimalleolar ORIF and, for whatever reason, a year or two later the physician removes the hardware. There are two plates and eight screws (four screws in each plate). Do you report: 

• 20680x10 for the two plates and eight screws? 

• 20680 just once because it is considered one internal device that was placed? 

• 20680x2 because you made two incisions to remove? 

A: Based on a discussion by the AAOS ICD-9 and CPT Coding Committee, removal of hardware used for a specific fracture typeâ€”regardless of the number of screws, plates, rods or incisionsâ€”would only be coded once. If there was an extraordinary of work involved (e.g., bone-buried screws, exceptional scar), then modifier -22 would be added with the usual accompanying note. 

Multiple use of 20680 would only be appropriate when the hardware removal was for another fracture unrelated to the first fracture (e.g.,ankle and humerus). Then modifier -59 would be used.


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## mbort (Oct 31, 2008)

this was also posted by another member that could cause an impact on coding:

the CCI policy manual states codes 20670 and 20680 "are not separately reportable if the removal is performed as a necessary integral component of another procedure" (Chapter 4 Version 13.3, pg 5)


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## peporter (Oct 31, 2008)

Thanks for all the feedback..

Mary, the original procedures were fractures with internal fixation and might have just been wires. It was a BWC claim from a crushed foot injury. He just stated hardware removal because of necrosis. Not a lot of detail in the op note.


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## mbort (Oct 31, 2008)

my first inclination is to say just code it one time, however, depending on the documentation (which you state is minimal, but since the patient had several different fractures and seperate incision for removal) you probably could bill it several times.  Then I say to myself, hypothetically speaking...you charge $1000 for each 20680/20670, which would ultimately be a $4000 case....does the 10 minutes it took him justify billing $4000?  Thats a judgement call.  

If it were my guys..I would only code it once and take the rath. (the only way I would give them all to them is if they had a couple of pages of documentation to CMA(cover my (_!_) ) but not a simple paragraph or two.  "incisions were made, pins were removed" just doesnt get it for me.

Thats my two cents.
I'm outa here for the day!!  Have a Happy and Safe Halloween everyone!!


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