Basics of implant Hardware removal CPT code 20680 & 20670

Medical coders have lot of confusion in coding removal of hardware procedures. For example, the use of CPT code 20670 and 20680 for removal of implant coding has got lot coding errors by medical coders. But, coders can easily differentiate and coder these CPT codes if they just follow the coding guidelines. Let us check more in detail to when to assign Hardware removal CPT code 20670 and 20680 in surgery facility.

Description of Hardware removal CPT code 20680 & 20670

20670 Removal of implant; superficial (eg, buried wire, pin or rod) (separate procedure)

During this exam, the physician makes a small incision overlying the site of the implant. The implant is located. The physician removes the implant by pulling or unscrewing it. The incision is closed with sutures and/or Steri-strips.

A skin incision is not required to appropriately to report CPT code 20670.

20680  Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)

In this exam, the physician makes an 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 layers using sutures, staples, and/or Steri-strips.

Read also : When to use Suture Removal CPT code

Coding Guidelines for Hardware removal CPT code 20680 & 20670

CPT Code 20680 describes a unit of service that is reported only once provided the original injury is located on one site, regardless of the number of screws, plates, rods or incisions. An example would be the removal of a single implant system, which may call for “stab” or multiple incisions (eg, intramedullary (IM) nail and several locking bolts).

CPT code 20680 reported more than once is appropriate only when the hardware removal is performed for another fracture(s) in a different anatomical site(s) unrelated to the first fracture (eg, ankle hardware and wrist hardware)

The coding guidelines for implant like cast, splint should be followed striclty.The cast, splint, or strapping procedure codes (29000-29750) may be coded only under the following circumstances:

• When the cast, splint, or strapping is an initial service performed without musculoskeletal-restorative treatment.
• When the cast, splint, or strapping is a replacement procedure performed during or after the postoperative global period.

When performed, the initial cast, splint, or strapping is always included in the restorative treatment of fracture and/or dislocation codes. Therefore, an individual who applies the initial cast, splint, or strapping, who will also report a code for the restorative treatment of the fracture on the same date of service, may not report a code for the application of a cast, splint, or strapping

CPT Code 20680 is reported once for each bone when removing internal fixation of healing fractures of “both bones” (radius and ulna) of the forearm when each bone is treated with separate plates and screws. If the plate and screw system is removed from the ulna at the same session as the radius, code 20680 with modifier 59 appended is reported.

These plates may be described by size (eg, small fragment system or small fragment plate) or by a trademark or type (eg, locking plate, periarticular plate, or polyaxial locking plate). Alternatively, the hardware may be described by the name of the manufacturer.  

Each plate and screw system removal procedure would be reported separately using code 20680 with modifier 59 appended to denote distinct procedural services (eg, different site or separate incision) performed on the same day by the same physician. Removal of any and all screws used for each fixation system (ie, one plate and its associated screws) is part of the service of the plate removal.

Global period for CPT code 20680 is 90 days and code 20670 has 10 days. This is one of the main difference between these two codes.

The MUE for 20680 is 3

An MUE (Medically Unlikely Edits) for a HCPCS/CPT code is the maximum units of service (UOS) that a provider would report under most circumstances for a single beneficiary on a single date of service. Not all HCPCS/CPT codes have an MUE.

CPT code 20680 should only be reported once if the injury is at one site. It can be assigned multiple times if there are removals at a different site or noncontiguous parts of the same bone.  For example, if a patient had both tibial and fibular shaft fractures with plate/screw removals of both bones, 20680 would be assigned twice, once for each bone.  Modifier 59 would be assigned to the second 20680 code to indicate it was a different site.

Read also: Coding Guidelines for Closed Fracture CPT codes

Supply Codes used with CPT code 20670

SA043 pack, cleaning, surgical instruments
SA048 pack, minimum multi-specialty visit
SA054 pack, post-op incision care (suture)
SA088 tray, surgical skin prep, sterile
SB001 cap, surgical
SB012 drape, sterile, for Mayo stand
SB013 drape, sterile, hand-upper extremity
SB014 drape, sterile, three-quarter sheet
SB015 drape, sterile, u-shape
SG068 plaster bandage (4in x 5yd uou)
SG079 tape, surgical paper 1in (Micropore)
SH047 lidocaine 1%-2% inj (Xylocaine)
SH069 sodium chloride 0.9% irrigation (500-1000ml uou)
SJ009 basin, irrigation
SJ010 basin, emesis
SJ011 bulb syringe (Asepto)
SB016 drape-cover, sterile, OR light handle
SB020 drape-towel, sterile OR blue (2 pk uou)
SB022 gloves, non-sterile
SB024 gloves, sterile
SB027 gown, staff, impervious
SB034 mask, surgical, with face shield
SB039 shoe covers, surgical
SC029 needle, 18-27g
SC051 syringe 10-12ml
SF021 cautery, patient ground pad w-cord
SF033 scalpel with blade, surgical (#10-20)
SF037 suture, nylon, 4-0 to 6-0, p, ps
SF040 suture, vicryl, 3-0 to 6-0, p, ps
SG015 bandage, Esmarch-Martin, sterile 3in x 9ft
SG025 cast, padding 4in x 4yd (Webril)
SG028 cast, stockinette 6in
SG041 dressing, 5in x 9in (Xeroform)
SG056 gauze, sterile 4in x 4in (10 pack uou)

Supply Codes used with CPT code 20680

SA043 pack, cleaning, surgical instruments
SA048 pack, minimum multi-specialty visit
SA054 pack, post-op incision care (suture)
SA080 pack, drapes, ortho, large
SA083 pack, protective, ortho, large
SA088 tray, surgical skin prep, sterile
SB016 drape-cover, sterile, OR light handle
SC029 needle, 18-27g
SC051 syringe 10-12ml
SF020 cautery, monopolar, pencil-handpiece
SF021 cautery, patient ground pad w-cord
SF033 scalpel with blade, surgical (#10-20)
SF036 suture, nylon, 3-0 to 6-0, c
SF040 suture, vicryl, 3-0 to 6-0, p, ps
SG016 bandage, Kerlix, sterile 4.5in
SG041 dressing, 5in x 9in (Xeroform)
SG056 gauze, sterile 4in x 4in (10 pack uou)
SG079 tape, surgical paper 1in (Micropore)
SH047 lidocaine 1%-2% inj (Xylocaine)
SH069 sodium chloride 0.9% irrigation (500-1000ml uou)
SJ009 basin, irrigation
SJ010 basin, emesis
SJ011 bulb syringe (Asepto)

EF014 light, surgical
EF015 mayo stand
EF031 table, power
EQ110 electrocautery-hyfrecator, up to 45 watts
EQ137 instrument pack, basic ($500-$1499)
EQ235 suction machine (Gomco)
EQ240 tourniquet system (Zimmer1200)

Sample Coded report for Hardware removal CPT code 20680 (removal of implant, deep)

PREOPERATIVE DIAGNOSIS: 

Retained orthopedic hardware, left elbow from prior olecranon fracture, status post ORIF.

POSTOPERATIVE DIAGNOSIS: 

Retained orthopedic hardware, left elbow from prior olecranon fracture, status post ORIF.

PROCEDURE: 

Open removal of hardware, left olecranon plate.

SURGEON: 

ASSISTANT: 

None.

ANESTHESIOLOGIST: 

ANESTHESIA:  

General 20 cc of 0.25% Marcaine.

PREOPERATIVE ANTIBIOTICS: Cefazolin 2 g IV.

ESTIMATED BLOOD LOSS: 

Minimal.

TOURNIQUET TIME:  

None.

SPECIMENS REMOVED: None.

IMPLANTS: 

None.

INDICATIONS FOR SURGERY:  

The patient is a pleasant 54-year-old female who injured her left elbow sustaining a closed olecranon fracture.Given the displacement, the patient offered surgical intervention.She underwent operative procedure, her fracture healed, but was having retained orthopedic hardware pain.Even though that her fracture is healed, we decided to proceed with elective hardware removal.The risks, benefits, and potential complications described, and the patient decided to proceed. 

DESCRIPTION OF PROCEDURE:  

The patient was met in the preoperative holding area where a consent form was once again reaffirmed by the patient. Her extremity was marked for surgery.The patient was brought back to the operative suite, placed supine on the operative table and succumbed to general anesthesia.Her left upper extremity was then prepped and draped in the usual sterile manner. 

Prior to proceeding, a formal time-out was performed by all team members present.IV antibiotics were administered.Her prior surgical incision was anesthetized with 0.25% Marcaine.We then used a #15 blade to incise the skin. Dissection was carried down to the plate.The plate as well as the corresponding screws were completely removed as well as the one headless screw was crossing her fracture site.

Her elbow was tested under fluoroscopy and this confirmed that she had complete union.The wound was irrigated.The deep tissue was closed with 4-0 Vicryl, subcutaneous tissue with 4-0 Vicryl, skin with 4-0 nylon.The wound was anesthetized with 0.25% Marcaine.Steriledressing was applied.At the end of the case, all counts were accounted for. The patient was awakened from anesthesia and transferred to PACU in stable condition.

CPT code 20680   Removal of implant; deep

ICD 10 T8484XA   Pain due to internal orthopedic prosthetic devices, implants and grafts, initial encounter