Orthopedic Coding Alert

Question: Can I charge for pin removal in the office following closed reduction and percutaneous pinning of a fourth metacarpal shaft fracture and fifth carpometacarpal joint fracture dislocation, even if I performed the original procedure? Florida Subscriber Answer: If the global period for the patient's procedure is over, then you can code for the pin removal using either 20670* (Removal of implant; superficial [e.g., buried wire, pin or rod] [separate procedure]) or 20680 (Removal of implant; deep [e.g., buried wire, pin, screw, metal band, nail, rod or plate]). If the patient is still within his or her surgical global period, most insurers will allow you to bill for the hardware removal, depending on carrier guidelines. If this is the case and the pin removal occurs at a site other than the operative room, submit your claim with modifier -58 (Staged or related procedure or service by the same physician during the postoperative period). If you must return to the operating room to remove the pins, append modifier -78 (Return to the operating room for a related procedure during the postoperative period) instead.