Superficial or Deep? 20680 vs. 20670
Q: How do you decide which CPT® is more appropriate, 20680 Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate) or 20670 Removal of implant; superficial (eg, buried wire, pin or rod) (separate procedure)? Our physician is reporting 20680 for removal of implants on toes, heel, and wrist. Would these be more appropriately reported as superficial removal?
A: The CPT® codebook provides some specific instructions for the proper application of 20680 (vs. 20670, or other codes). These include:
(To report removal of hardware from proximal radius, other than radial head prosthesis, use 20680)
(To report removal of hardware from the distal humerus or proximal ulna, other than humeral and ulnar prosthesis, use 20680)
(To report removal of hardware, other than humeral and/or glenoid prosthesis, use 20680)
Beyond these circumstances, you should report 20670 for superficial implant removal, such as when the physician makes a small incision and removes the implant by pulling or unscrewing it. The incision is closed using sutures and/or steri-strips, but no layered closure is involved. Such procedures may be performed in the physician office.
Note that 20670 is a designated separate procedure, and should be reported only if it is the only procedure performed at a particular anatomic area/operative site. If the physician performs the service with another procedure involving the same area, you may not separately bill 20670. If you have any doubt whether separate coding is allowed, check the National Correct Coding Initiative (NCCI) edits.
Deep implant removal procedures (20680) are usually performed in an ambulatory surgical center or other facility setting (i.e., not in the physician office). The physician must make a deep incision (typically below the level of muscle) overlying the site to visualize the implant, and may use instruments to remove the implant from the bone. The physician repairs the incision by layered closure.
Per the AMA’s CPT Assistant (June 2009) and AAOS (American Academy of Orthopedic Surgeons) guidelines, you should report a single unit of 20680 for a single fracture site or area of injury, even if multiple stab incisions where necessary to remove all of the hardware. For example, you would not report multiple units of 20680 when an intramedullary rod (IM rod) is removed. The IM rode cannot be removed via a single incision because there are locking screws on both ends of the rod; therefore, stab incisions are made at two sites to release the screws. But, because the IM is considered to be a single implant system for fixation of one fracture site, you may report 20680 only one time.
Reporting multiple units of 20680 is appropriate when fixation device(s) are removed from separate fractures at different anatomical sites, or for two fractures that are classified as noncontiguous on the same bone (e.g., proximal and distal fracture sites). For example, you may report 20680 and 20680-59 Separate procedure for a bimalleolar fracture if screw(s) are removed from the lateral malleolus (distal fibula), and a plate with screws are removed from the medial malleolus (tibia) through a separate incision.