Orthopedic Coding Alert

Question: When you remove hardware from a patient, can you charge for each piece you remove or do you just charge code 20670 one time?

Beth Ohrt
Crossroads, Texas

Answer: As is often the case in coding, there is more than one right answer depending upon the specific circumstances involved. The narrative for 20670* states removal of implant; superficial, (e.g., buried wire, pin or rod) (separate procedure). Surely this terminology has led many coders to the conclusion that this code can be reported for each implant that is removed, but this is not always the case.

An example would be when your surgeon is removing two k-wires from a patients wrist. Although it may seem perfectly logical to report 20670 twice, do not do so, because both implants are in the same anatomic site. Under these circumstances, you would report 20670 only once.

On the other hand, if your surgeon is removing a pin from the left index and ring fingers, it is appropriate to report 20670 twice. This is so because the implants are in two different anatomic sites. Naturally, you will need to append a modifier to the second code, and the correct modifier would be -59 (distinct procedural service). According to CPT, this modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This may represent a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury. If you do not append this modifier to the second CPT code, you most likely will see it denied by the carrier as a duplicate.

This Reader Question was answered by Heidi Stout, CPC, CCS-P, coding and reimbursement specialist at University Orthopaedic Associates in New Brunswick, N.J.