Anesthesia Coding Alert

Question: What surgical and anesthesia codes should I report for sternal wire extrusion?

Florida Subscriber

Answer: The surgical code could be either 20670 (Removal of implant; superficial [e.g., buried wire, pin or rod] [separate procedure]) or 20680 (... deep [e.g., buried wire, pin, screw, metal band, nail, rod or plate]). Surgeons will place most sternal wires superficially, but verify how deep the surgeon went to know which code applies.

Codes 20670 and 20680 cross to anesthesia codes 00400 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified) or 00540 (Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum [including surgical thoracoscopy]; not otherwise specified).

Note: The Crosswalk does not list these anesthesia codes with 20670 and 20680, but remember the Crosswalk is only a beginning-point guide for your coding. You still need to use your best judgment with individual cases.

Other problems -- such as dehiscence or separation -- frequently occur during sternal wire removal. The surgeon might need to perform sternal debridement during the encounter (21627, Sternal debridement), which also crosses to anesthesia code 00540.