Revenue Cycle Insider

Question: Can someone please help me to understand why my claims with 20680 are always being downcoded to 20670? I work for hand surgeons that often pull K wires out and/or remove plates from fingers or wrists. Nearly every time I submit a claim with code 20680 on it, the payer downcodes the code to 20670 and I don’t understand why.

California Subscriber

Answer: When you say the practitioner is “pulling” the wire out, this probably indicates the wire is very close to the surface of the skin. This may be why your claims with 20680 (Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)) are being downcoded to 20670 (Removal of implant; superficial (eg, buried wire, pin or rod) (separate procedure)). Based on the differences between the codes, 20680 is used for k wires that are buried deep in the skin or tissue, while 20670 are for those near the surface.

To prevent this issue in the future, if you believe 20680 is truly accurately describing the procedure being performed, suggest that your practitioner provide a detailed description of the dissection beneath the skin or subcutaneous tissue, including details as to whether it’s down to or through the fascia or muscle or down to the bone where the pin is located and removed.

Lindsey Bush, BA, MA, CPC, Production Editor, AAPC