Orthopedic Coding Alert

Question: We have a patient who is having a total ankle arthroplasty (27702, arthroplasty, ankle; with implant [total ankle]) along with removal of hardware (20680 ) and a short-leg cast (29405). To complicate matters, however, he has a fusion that must be taken down. How should I code a takedown of a solid fusion (i.e., take-down arthrodesis)?

New Jersey Subscriber

Answer: According to the national Correct Coding Initiative (CCI), removal of hardware, 20680 (removal of implant; deep [e.g., buried wire, pin, screw, metal band, nail, rod or plate]), is a component code of the total ankle arthroplasty with implant, 27702 (arthroplasty, ankle; with implant [total ankle]). Therefore, the removal of hardware cannot be billed separately and is considered part of the total ankle procedure. According to CPT 2000 guidelines, cast application, including removal of cast, is reported only as a replacement procedure or when the cast application is an initial service performed without a restorative treatment or procedure. Therefore, the short-leg cast application, 29405 (application of short leg cast [below knee to toes]), is considered part of the total ankle procedure.

According to CPT 2000, there is no specific code for a take- down of an arthrodesis of the ankle or the subtalar joint of the ankle. When there is no specific code listed to describe a procedure, it is appropriate to use the unlisted procedure code listed under the appropriate anatomical section. The unlisted procedure code for the ankle is 27899 (unlisted procedure, ankle or leg). To ensure appropriate reimbursement, always send a copy of the operative report with the claim form when using unlisted procedure codes.

If the takedown, or removal, of arthrodesis is a distinct or independent procedure from the total ankle replacement, 27899 should be submitted with the -59 modifier (distinct procedural service) to identify that this procedure was not part of the total ankle replacement.

Source for this Reader Question is Catherine Brink, CMM, CPC, president of Healthcare Resource Management Inc., a practice management and reimbursement consulting firm based in Spring Lake, N.J.