This installment of “Spotlight on CPT” will present information on CPT coding for removal of superficial or deep implants. CPT codes 20670 or 20680 pertain to the hardware used in fixation procedures and are assigned for removal of these devices with descriptions as follows:
20670 – Removal of implant; superficial (eg, buried wire, pin, or rod) (separate procedure)
20680 – Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod, or plate)
When assigning 20670, it is important to note that a CPT Assistant from April 2012 indicated that there is no requirement for an incision to be made to assign this code.
From June 2009 and January 2018 CPT Assistants we learn that CPT code 20680 represents a unit of service. Coding professionals should bear in mind that the code should only be reported once if the injury is at one site. For example, if a humeral fracture was repaired with an intramedullary nail and locking screws, and at the time of removal, two stab incisions were made to remove the locking screws and then the nail, one unit of 20680 would be coded. The multiple incisions were made to remove the single implant system. Do not assign a code for each incision made.
It is appropriate to assign 20680 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.
Inclusive components of both codes are the use of anesthetic, any contrast (before, during, or after the procedure), and local infiltration of any medication as noted in a January 2018 CPT Assistant.
It is not only fracture fixation procedures to which these codes apply. They can also be used in other circumstances, such as revision of an ACL tear, where the original graft and screws had to be removed prior to the second ACL reconstruction. In this instance, the removal of the screws would be assigned to 20680 as noted in a November 2016 CPT Assistant. National Correct Coding Initiative (NCCI) edits do state that if the removal is an integral component of another procedure, it cannot be separately assigned. This would be exemplified if a fracture malunion required correction necessitating a plate removal and replacement, the removal would not be coded.
Now, light has been shed on implant removals.
About the Author
Dianna Foley, RHIA, CHPS, CCS, CDIP is
OHIMA's Education Coordinator. Dianna has been an HIM
professional for 20 years. She progressed through the ranks of coder,
department supervisor, and department director, to her current role as a
coding consultant. She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.
