Wiki help with casting

[ggparker14]

Need help from other coders.

When removing k-wire from fracture of the metacarpals, the physician applies a short arm cast. Can you bill the cast with 20680 for the removal of the k-wire or is the cast included in the 20680?

Any help is appreciated. Thank you.

 

[twosmek]

First question is did she remove the k-wires without an large incision. If it was only a small incision overlying the site of the implant (wire) then you should be using 20670 not 20680 only use that code if the implant is buried "deep."
From Orthopedic Coding compainion
discription of 20680
"The physician makes and incision overlying the site of the implant. Deep dissection is carried down to visualize the implant, which is usually below the muscle level and within bone. The physician uses instruments to remove the implant from the bone. The incision is repaired in multiple layers using sutures, staples, and/or steri-strips."

For 20670
"The physician makes a small incision overlying the site of the implant, The implant is located. Thy physician removes the implant by pulling or unscrewing it. The incision is closed with sutures and/or steri-strips."

But no you cannot code for that application of the cast it is included in both 20670 and 20680 according to the AAOS Global Service Data Book.

I had to explain this out to my MDs as well they always tried to code the 20680 as well.