Orthopedic Coding Alert

Question: My doctor performed a removal of pins in the right hip with scar revision. This went beyond a regular pin removal, as the whole process took longer due to the revision. How should I code this for maximum reimbursement?

Arkansas Subscriber
 
Answer: The code for the pin removal is 20680 (removal of implant; deep [e.g., buried wire, pin, screw, metal band, nail, rod or plate]). In the American Academy of Orthopedic Surgeons (AAOS) Complete Global Service Data Guide, it appears that scar revision is bundled with this procedure. Under intraoperative services included in the global service package is surgical approach, with necessary identification, isolation and protection of anatomical structures, including hemostasis and nerve stimulation or skin scar revision. The guide also lists all the other CPT codes bundled into 20680.
  
But, under items not included in the global surgical package, it says: Complicated wound closure, or closure requiring local or distant flap coverage and/or skin graft, when appropriate.
  
If your physician feels the additional work he or she did justifies reporting an additional code, report the appropriate complex repair code in addition to 20680.