In the field of orthopedic surgery, treatment often involves internal implants to ensure proper recovery. But what happens once those skeletal parts are perfectly aligned and healed? Their surgical removal becomes necessary. However, this procedure has its own set of billing and coding complexities.
For orthopedic practices performing these procedures, capturing every detail is critical to ensure accurate reimbursement and a steady cash inflow. Even a seemingly straightforward removal can hide nuanced coding challenges, leading to frustrating denials and revenue loss.
Luckily, this guide cuts through the confusion, offering essential insights into CPT code 20680. Read it till the end to equip yourself with the necessary knowledge and collect faster payments every time.
CPT Code 20680 – Description
CPT code 20680 is from the ‘General Introduction or Removal Procedures on the Musculoskeletal System’ code range. It covers the surgical removal of deep implants (plates, wires, bands, pins, or rods).
Here’s how it works! Skeletal fixation devices are often needed to join skeletal parts. These support implants maintain normal alignment of skeletal parts as healing occurs after skeletal deformities or injuries (fractures). Once the defect heals completely, the physician removes the implant.
Scenarios Where CPT Code 20680 is Applicable
Now, before we look into how to properly bill this code or which modifiers to apply, let’s explore some real-world clinical scenarios:
Distal Radius Plate and Screw Removal
Picture a 47-year-old male patient who underwent a surgical repair of a displaced distal radius fracture with a volar plate and screws a year ago.
The patient visits the orthopedic surgeon and complains about persistent irritation and pain with wrist flexion. Imaging studies confirm complete healing. Thus, the orthopedist diagnoses that the pain and irritation can be due to hardware prominence.
Therefore, the orthopedist surgically removes the support implant, i.e., the plate and screws from the distal radius.
Here, CPT code 20680 applies.
Femoral Intramedullary Rod Removal
Imagine a 32-year-old patient who had experienced a femoral shaft fracture after a vehicle accident almost two years ago. At that time, the orthopedic surgeon treated the fracture with an intramedullary rod and screws.
Fast forward to today, the fracture is completely healed. The patient visits the orthopedic clinic and shares his desire to get the hardware removed due to discomfort. Besides, he plans to return to high-impact activities. Therefore, the orthopedist surgically removes the intramedullary rod and locking screws from the femur.
Here, the orthopedic surgeon bills CPT code 20680.
Tibial Shaft Fracture Hardware Removal
Consider a 29-year-old patient who received an intramedullary nailing for a tibial shaft fracture six months ago. Now, the fracture has healed completely. However, the patient complains of discomfort around the ankle and knee where the locking screws are prominent.
As a result, the orthopedist surgically removes the intramedullary nail and all locking screws from the tibia.
The surgeon reports CPT code 20680 for the performed service.
Applicable Modifiers for CPT Code 20680
The following are a few of the applicable modifiers related to the removal of deep implants:
Modifier 22
Let’s say you removed the hardware, but the scar was exceptional, and the screws were bone-buried. As a result, it took significantly more time and effort to perform the removal than was typically required.
So, will you report CPT code 20680 as it is and receive the typical reimbursement? No. In such scenarios, you append modifier 22 to ensure fair reimbursement.
Modifier 52
Sometimes, the hardware is too deeply embedded. The orthopedist surgeon initiates the procedure but eliminates it midway without completing the removal of the buried screw, plate, rod, etc. The million-dollar question then becomes: Will you receive reimbursement for this incomplete service? Yes, you will.
However, you should append modifier 52. Why? Because the procedure was terminated at the orthopedist’s discretion without fully completing the scope described under CPT code 20680. You will typically receive a percentage of the actual payment, reflecting the portion of work performed (e.g., 50%).
Modifier 59
As per the Centers for Medicare & Medicaid Services (CMS), a single unit of CPT code 20680 covers the removal of all hardware (plates, rods, screws, wires, etc.) from a single anatomic site. Therefore, never bill multiple units of this CPT code for removing individual hardware from the same site.
However, you can bill multiple units if the orthopedist removes hardware from a different anatomical site in the same session. In such cases, you must append modifier 59 to indicate that the service is distinct and separately identifiable. But, use it only if any of its sub-modifiers, X{EPSU}, do not offer better specificity.
CPT Code 20680 – Billing & Reimbursement Guidelines
Discussed below are the essential billing and reimbursement requirements for CPT code 20680:
Bundling Considerations
You must be aware of the National Correct Coding Initiative (NCCI) edits. CMS introduced these bundling rules to promote coding accuracy and prevent improper payments. Here’s a glimpse into when you cannot bill for the removal of a support implant (CPT code 20680) separately:
- Do Not Bill It, If Part Of Another Procedure
Avoid reporting it when it is performed as an integral part of another procedure. For instance, a patient visits the orthopedic clinic with a non-healing bone fracture. He is scheduled for a bone revision surgery, such as re-fixation or bone graft.
However, the surgeon must first remove an existing deep implant (CPT code 20680) before performing the necessary bone revision. In this situation, the hardware removal is an integral step for successfully performing the primary procedure. Therefore, you cannot bill CPT 20680 along with the relevant fracture revision code.
- Do Not Bill It, During Cardiac Reoperations
You cannot report CPT code 20680 if the wire suture removal occurs during cardiac reoperations. It can be any surgery in which the cardiologist reopens the chest to perform a cardiac procedure, such as valve repair or replacement etc.
- Do Not Bill It, During Sternal Procedures
You should not bill CPT code 20680 separately when the surgeon performs the removal of a deep implant during sternal procedures. These may include resection of the sternal bone, debridement of the sternal infection, or closure of a separated median sternotomy.
Demonstrate Medical Necessity
Your documentation must establish the medical necessity of the deep hardware or implant removal (CPT code 20680). Simply put, it must state the reason for performing the procedure. Some of the medical indications that lead to it include:
- Radiographic evidence, such as X-ray, supports complete fracture healing.
- The patient experiences discomfort, pain, or irritation due to the plate, screws, rod, or other implants.
- Planned removal since it was a part of a multi-stage treatment plan.
- The patient had an infection associated with the supporting implant.
- The orthopedist removed hardware due to malunion or non-union.
Ensure Complete Documentation
Detailed documentation is another key billing requirement to ensure timely reimbursements. Therefore, your operative report for billing CPT code 20680 must cover the following:
- Date of service.
- Details of what type of implants the orthopedist removed and their specific locations.
- Explain the medical indication that led to the removal.
- Mention the technique employed by the orthopedic surgeon for removing the implants, including incision size, depth, and complications (if any).
- Confirm clearly in notes whether the removal was complete or partial, with reasoning.
- Include details of the original injury that led to the implant placement in the first place.
Summary
It is completely understandable if you feel overwhelmed by the intricacies of billing the removal of deep implants. To make it easy, let’s summarize all key takeaways from this guide before concluding it.
First, we explained the descriptor of CPT code 20680. It covers the surgical removal of deep implants, such as plates, wires, bands, pins, or rods.
Next, we shared some clinical scenarios where this CPT code applies. These include tibial shaft fracture hardware removal, femoral intramedullary rod removal, and distal radius plate and screw removal.
We also shared some of the applicable modifiers for CPT code 20680, including modifiers 22, 52, and 59. Finally, we looked into the essential billing and reimbursement guidelines related to this code. Hopefully, this guide will become your go-to resource when billing for deep implant removals. However, if you need help, consider MediBillMD’s professional orthopedic billing services, as the suite includes medical coding and accurate charge entry.
