Otolaryngology Coding Alert

Question: My physician performed 21470 on a patient. After a month, it was time to remove the arch bars, I'm not sure what to code. I've heard that removal of a fixation device is not reported separately. Is this correct -- even if the procedure involved anesthesia and a return to the operating room?

Florida Subscriber

Answer: You can report the arch bar removal separately -- in which case you should code 20670 (Removal of implant; superficial [e.g., buried wire, pin or rod] [separate procedure]). CCI Edits do not consider this code an inclusive component of 21470 (Open treatment of complicated mandibular fracture by multiple surgical approaches including internal fixation, interdental fixation, and/or wiring of dentures or splints). Also, some patients may be taken out of fixation immediately after surgery, but others are left in fixation for a month or more --" just as your case indicates.

The American Association of Oral and Maxillofacial Surgery (AAOMS) Committee on Health Care and Advocacy has this to say: "The removal of arch bars placed in the treatment of a fracture is a separately billable service and not included in the global package of the fracture repair surgery -- regardless of who (same surgeon or different surgeon) placed the arch bars in the first place."

Option: You may append a modifier (i.e., modifier 58, Staged or related procedure or service by the same provider during the postoperative period) if the removal is performed within the global period of the initial surgery. If you do not add the staged procedure modifier 58 and you are in the global period, the removal will not be paid and be considered part of the global service.