july 2009

CLARIFICATION OF HARDWARE REMOVAL

In the latest edition of CPT Assistant the AMA has clarified usage of CPT codes 20670 and 20680 with specific guidelines as to how these codes should be reported. Take CPT code 20680 for instance, this code is used only one time to describe a unit of service based on a single fracture site or area of injury, even if multiple stab incisions where necessary to remove all of the hardware.

Reporting 20680 multiple times is only indicated when fixation device(s) are removed from separate fractures at different anatomical sites or for two fractures that are considered noncontiguous on the same bone (like a proximal and distal fracture site).

It would be appropriate to report 20680 and 20680-59 for a bimalleolar fracture when screw(s) are removed from the lateral malleolus (distal fibula) and then a plate with screws are removed from the medial malleolus (tibia) through a separate incision. It doesn’t matter what type of implant system was removed the deciding factor was that it was two different fracture sites. You could have removed a K-wire from the fibula and still had the plate with screws in the tibia, that would be reported as 20680 and 20670-59.

Incorrect reporting would be multiple use of 20680 when an intramedullary rod (IM rod) is removed. This usually cannot be accomplished through one incision since there are locking screws on both ends of the rod so stab incisions are made proximal and distal to release the screws – this is still considered a single implant system for fixation of one fracture site so only report 20680 one time.