Radiology Coding Alert

Here’s how to identify an implant that comes loose and what it means for coding.

Radiology practices didn’t have many CPT^® code changes to prepare for in 2022, but the code set did see the addition of an important guideline. New wording added to the radiology guidelines breaks down the definitions of foreign bodies and implants so you can apply the correct codes for your claims.

Check out the new radiology guideline and understand how it applies to two scenarios.

Understand This New Guideline for the New Year

The updated Radiology section guidelines for 2022 define an implant as “an object intentionally placed by a physician or other qualified health care professional for any purpose (e.g., diagnostic or therapeutic),” while a foreign body is considered an object that’s unintentionally placed. The term “unintentionally placed” includes placement via trauma or ingestion.

The guideline goes on to state that an implant is considered a foreign body for coding purposes if the implant “(or part thereof) has moved from its original position or is structurally broken and no longer serves its intended purpose or presents a hazard to the patient.” You are to follow this guideline unless CPT^® coding instructions direct otherwise or there is a CPT^® code that specifically describes the removal of the broken or repositioned implant.

Recognize Unintentional Placement

Scenario: A 36-year-old patient was remodeling their bathroom when a board suddenly broke free and fell on them. They experienced pain in their left shoulder for a few days, along with swelling and discoloration before presenting to an urgent care clinic, where the physician orders X-rays of the shoulder. The radiologist captured two views of the shoulder, which revealed a small item inside the shoulder. A physician performs a simple surgery to open the patient’s shoulder and remove a nail.

In this scenario, the radiologist performs X-rays to determine the cause of the patient’s pain. X-rays also happen to be an ideal modality for visualizing foreign bodies. The procedure allows “foreign bodies of metal, glass, and stone to be visualized” easier (www.ncbi.nlm.nih.gov/pmc/articles/ PMC5652558/). The radiologist’s report refers to the nail as a small item, which allows it to be treated as a foreign body as defined in the CPT^® guidelines since the nail was placed in the patient’s body via an accident or trauma.

You’ll assign 73030 (Radiologic examination, shoulder; complete, minimum of 2 views) to report the X-rays, and the operating physician will assign 23330 (Removal of foreign body, shoulder; subcutaneous) to report the removal of the nail from the patient’s shoulder.

Know When an Implant Becomes a Foreign Body

Scenario: A patient presents to the orthopedist with acute left ankle pain. The patient had surgery about 10 years ago to repair an open fracture of the same ankle. The physician examines the patient’s ankle and discovers a growth near the back of the foot. Following the physical evaluation, the physician orders X-rays on the ankle. The radiologist captures two X-ray views, which reveal the screw that another physician inserted during the patient’s initial ankle surgery is moving out of the bone. A week later, an orthopedic surgeon removes the screw from the patient’s foot.

For this scenario, the screw in the patient’s ankle has migrated inside the body over time. While the screw is no longer in its original position, it is not considered a foreign body. The guideline states that you should use a CPT^® code that specifically covers the implant removal. With that in mind, the surgeon will assign 20680 (Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)) to report the removal of the screw from the patient’s ankle. You’ll report 20680 only once on a claim, no matter how many screws, pins, rods, etc., are removed.

According to the January 2018 issue of CPT^® Assistant, “Code 20680 describes a unit of service that is typically reported only once, provided the original injury is located at only one anatomic site, regardless of the number of screws, plates, or rods inserted, or the number of incisions required for removal.”

Additionally, you’ll need to report 73600 (Radiologic examination, ankle; 2 views) to ensure reimbursement for the X-rays of the ankle.