Orthopedic Coding Alert

Question: In the September 2002 issue, you suggested that modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) could be appended to 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]) for pin removals during the postoperative period. But when we do this, our claim gets denied. Is there any way around this?

Illinois Subscriber

Answer: Although no specific written guidelines exist for dictating when the global fee includes pin removal, here is a good rule of thumb: The global fee includes exposed pins pulled in the office during the global postoperative period. Therefore, this is not separately reportable.

If the orthopedist removes a superficial implant through an incision during the postoperative period, however, you should report it using 20670-58. You should report deep implant removal requiring more extensive surgical dissection with 20680-58.

Remember that modifier -58 refers to planned pin removal. If the physician suddenly removes the pins due to an infection or other complication, modifier -78 (Return to the operating room for a related procedure during the postoperative period) would be more appropriate.