Orthopedic Coding Alert

Question: My orthopedic surgeon performed a tibia hardware removal and then a fibula hardware removal. Since he removed multiple implants through separate incisions during an operative session, can I report 20680 more than once ?

Arkansas Subscriber

Answer: You can report 20680 (Removal of implant; deep [e.g., buried wire, pin, screw, metal band, nail, rod or plate]), 20680-59 (Distinct procedural service) when the orthopedist removes hardware from the tibia and the fibula. They are separate hardware to treat two separate fractures.

In other words, if the orthopedist performs the hardware removal on another fracture unrelated to the first fracture (such as an ankle or humerus, or the fracture site is distal and the other proximal), you can report two units of 20680 with modifier 59 on the second unit.

Caution: The American Academy of Orthopaedic Surgeons (AAOS) has stated that you should report the removal of hardware used to repair any given fracture with one unit of 20680, regardless of how many screws, plates, pins, etc., the physician removes.

You would typically report the removal of the implants only once, regardless of the number of incisions.

To tell if you should use one unit or two, check the fracture care codes and ask, Are they the same? If theyre different, you may report two units, if the implants are not all parts of the same fixation device. The  hardware has to be two independent entities; otherwise, you should consider this one fixation device and one unit of 20680.

--Reader Questions and You Be the Coder were reviewed by Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network LLC; and Bill Mallon, MD, orthopedic surgeon and medical director at Triangle Orthopaedic Associates in Durham, N.C.