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
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