# 20680, separate or bundled?



## JOGelico (Sep 15, 2011)

Is the removal of hardware separately reportable in this situation:

*Operation*: Conversion of previous right hip surgery with THA and removal of deep fracture implant through separate incision

_The patient is status post a failed open reduction with internal fixation of a subcapital fracture of the right hip that healed with a marked malunion and developed secondary acetabular arthritis. This required removal of three previously placed cannulated screws. There were removed from a distinct surgical incision through a separate fascial incision due to intervening hardware. _


I understand that when a patient undergoes a conversion any previous placed internal hardware needs to be removed and is considered to be an integral component of the primary procedure but if the removal is through a separate incision can this be reported with modifier 59 and be entitled to full reimbursement?

Any help is appreciated!
JO


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## JOGelico (Sep 19, 2011)

Any insight on this, please?


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## hrivera (Sep 21, 2011)

*Bundled*

I believe it should be bundled, regardless of the separate incision. If that hardware was placed for a fracture were you are now placing the THA components it would be bundled. I read in Orthopaedic Coding Alert that removal of hardware is per fracture, not per incision.  For example, if you had one femur fracture with three screws and needed separate incisions to remove each screw, you still would only bill 20680 once, since all screws were placed for the same fracture.  I would use this same thinking for your scenario.


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## JOGelico (Sep 21, 2011)

Great! I appreciate the info and it makes complete sense to me.


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