Neurosurgery Coding Alert

Question: How can I report C7 bilateral screw removal followed by replacement with rescue screws?

Nevada Subscriber Answer: You won't find a single CPT code to describe removal and replacement of cervical screws: You must report each portion of the procedure separately.

Claim 20680 (Removal of implant; deep [e.g., buried wire, pin, screw, metal band, nail, rod or plate]) for removal of the screws at the cervical vertebra. This code specifically refers to removal of an implanted screw.

Although you may not append modifier -50 (Bilateral procedure) to 20680, according to the Physician Fee Schedule database, the code descriptor refers to a single implant. Therefore, if the surgeon removes multiple screws (as you indicate), you may report multiple units of 20680 with modifier -59 (Distinct procedural service) appended to the second (and any subsequent) units to indicate a separate anatomic location.

To report screw replacement, you should choose 22849 (Reinsertion of spinal fixation device). Neither CPT nor the National Correct Coding Initiative bundles 20680 with 22849, so you should encounter no problems reporting these codes together.