# Hardware removal - units



## orthopaedic01 (Sep 29, 2009)

Patient had 5 pins placed during wrist SLAC wrist reconstruction.  The doctor is now removing the 5 pins, with 5 seperate incisions.  Is it appropriate to charge 5 units?


----------



## Bella Cullen (Sep 29, 2009)

I was always taught if dr made all separate incisions then you can bill multiple times. so I would say yes x5.


----------



## mbort (Sep 30, 2009)

if the hardware (pins) were placed for the same fracture, then this would only be codable one time.

CPT ASST June 2009 reads:

Removal of Deep or Superficial Bimalleolar Plate and Screws 
Code 20680 would be used to describe the removal of a plate (eg, periarticular plate, locking plate, or one-third tubular plate) and screws from the fibula in a healed bimalleolar ankle fracture. If deep buried medial malleolar screws are removed from the tibia's medial malleolus at the same session, use code 20680. 

If removing superficial screws from the fibular fracture, code 20670 should be reported. If superficial screws are removed from the tibia's medial malleolus at the same session, the procedure is reported using code 20670 with modifier 59 appended. 

Multiple use of code 20680 would be appropriate only when the hardware removal was performed for another fracture in a different anatomical site unrelated to the first fracture (eg, ankle and humerus). In these circumstances, modifier 59, Distinct procedural service, would be appended to subsequent uses of the code. For example, two different and noncontiguous implants are removed from two different bones or two different (noncontiguous) sites on the same bone using multiple incisions. Depending on whether the implants were superficial or deep, code 20680 may be reported twice or codes 20680 and 20670, Removal of implant; superficial (eg, buried wire, pin, or rod (separate procedure), may each be reported.


----------



## orthopaedic01 (Sep 30, 2009)

I understand the hardware removal as it applies to fractures. However, this case is not from a fracture, it was a SLAC wrist (scapholunate advanced collapse.  How do the rules apply in this case?


----------



## mbort (Oct 3, 2009)

personally..I would only code it once


----------



## magnolia1 (Oct 4, 2009)

I'm with Mary on this one, I would only code it once.


----------



## Bella Cullen (Oct 5, 2009)

I'm curious as to why both of you would only code this one as once? 
Dr did 5 separate incisions. 
I could see if dr removed 5 pins or screws under 1 incision then I would say only bill once, but if he made 5 separate incisions to remove 5 separate pins then he/she would have to close all 5 incisions separate. 
I would just like to see your reasoning on this. 
Thank you, 
Melissa


----------



## mbort (Oct 6, 2009)

my decision is based on the same concept that the AMA uses for hardware removal of a fracture


----------

