Wiki REMOVAL HARDWARE W/PLACING NEW SCREWS

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RebeccaMoney

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I need help with CPT's. We are removing symptomatic hardware; placing Osteal bone wrap; then placing four locking screws in wrist. Previous surgery done was 25800 (Arthrodesis, wrist). Diagnosis is symptomatic hardware with incomplete arthrodesis.
Brief description: ...the prominent screws were then removed. Gross motion at the attempted fusion site was noted. The nonunion was then cleared with the rongeur. Osteal bone wrap was then placed in the intersection of this area and four locking screws were replaced distally.
I've got 20680 but not sure of the other CPT(s).
Thank you,
 
This surgery appears to be a revision of a failed arthrodesis (pseudarthrosis). It would be coded with an arthrodesis code (25800-25830). The removal of the prominent/symptomatic screws is included. Per the NCCI Policy Manual, 20680 for removal of internal fixation, deep, cannot be coded with a more extensive procedure at the same site: "There are CPT codes (20670 and 20680) for removal of internal fixation devices (e.g., pin, rod). These codes are not separately reportable if the removal is performed as a necessary integral component of another procedure. For example, if revision of an open fracture repair for nonunion or malunion of bone requires removal of a previously inserted pin, CPT code 20670 or 20680 is not separately reportable." (Source: CMS NCCI Policy Manual Chapter 4 https://www.cms.gov/files/document/chapter4cptcodes20000-29999final11.pdf)
 
Tough to say without a full op note. Agree it looks more like revision fusion since it failed (nonunion). Agree with Kimberly that it's more 25800-25830 area depending. It's much more than just a hardware exchange like when they just replace a screw. You would also want to check it out to see why it failed, noncompliance such as smoking, poor bone quality, etc. Depending on the documentation you would want to add the co-morbid conditions to explain the complication. Especially if you are coding this in the global for the prior case.
 
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