Podiatry Coding & Billing Alert

Question: The podiatrist removed screws from two separate incisions on a patient. Medicare denied the claim, stating we could only bill one unit for 20680 for fracture care. This particular procedure was unrelated to any fracture care, so how should we handle this?

Massachusetts Subscriber

Answer: Your claim might have been denied if you used an incorrect ICD-9 diagnosis code. If the problem stems from pain because of the orthotic device, the correct diagnosis is 996.49 (Other mechanical complication of other internal orthopedic device, implant, and graft).

Also consider: The explanation in the Podiatry Coding Companion states, "... if two separate unrelated incisions are performed to remove different implants, report 20680 twice and append 59."

Because you have two separate incisions unrelated to fracture care, follow this guideline and submit 20680 (Removal of implant; deep [e.g., buried wire, pin, screw, metal band, nail, rod or plate) for each incision, then append modifier 59 (Distinct procedural service) to the second line on your claim form. Be prepared to appeal your claim with supporting documentation.

Carrier checkpoint: Although the Podiatry Coding Companion recommends 20680, not every carrier accepts it in this situation. Some refuse 20608 but accept 20670 (Removal of implant, superficial [e.g., buried wire, pin or rod] [separate procedure]). Don't report 20670 simply because the carrier might approve it, but also don't overlook the option if it applies to your case.