Neurosurgery Coding Alert

Question: The surgeon removed a patient’s buried wire skull implant that they did not install. I’m seeing codes for superficial and deep implants, but I’m not sure which one to use. Could you explain the differ between superficial and deep implant removals?

Arkansas Subscriber

Answer: You’ll report superficial implant removals with 20670 (Removal of implant; superficial (eg, buried wire, pin or rod) (separate procedure))

Superficial characteristics: These are implants that are located closer to the surface of the skin; as such, the procedure for removing superficial skull implants is generally less complex and invasive compared to deep skull implant removals. It may involve a shorter length of stay in the hospital and lower average costs. Note that this code has a “separate procedure” designation, which means that it is typically bundled into other larger procedures occurring in the same operative location.

You report deep implant removals with 20680 (Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)).

Deep characteristics: These are implants that are located deeper from the skin surface. The procedure for removing deep skull implants is typically more complex and may require a higher level of training, precision, and sophisticated technology. Deep skull implant removals may involve a longer length of stay in the hospital and higher average costs compared to superficial skull implant removals.