General Surgery Coding Alert

Implant Removal

Question: Our surgeon removed four screws and one plate from the fibula as well as one screw from the tibia all on the left ankle of a Medicare patient. Could you help me with the correct codes and modifiers?

Elizabeth Menduke
Primary Billing Service, Torrance, Calif.

Answer: The code for removal of deep hardware is 20680 (removal of implant; deep [e.g., buried wire, pin, screw, metal band, nail, rod or plate]). Wanda Oplinger, CPC, billing department supervisor at Cardiology Consultants Ltd., a 10-cardiologist practice in Belleville, Ill., says that this code is billed once per incision, not once per object removed. Therefore, you dont get to bill and be paid for each screw taken out if these are removed via the same incision.

If more than one incision is performed, 20680 could be charged again with modifier -59 (distinct procedural service) attached to indicate the procedure is being performed again at a separate site.