Part B Insider (Multispecialty) Coding Alert

Published on Sun May 07, 2006 PDF

Find out which CPT code could put $491 in your pocket

You know that when you bill for hardware removal, you have two options for internal and external fixation. Don't take guesses on which codes you should report because PBI has the answers for you.

CPT offers two applicable codes for the removal of internal fixation hardware, and choosing between the two will depend on how far your surgeon has to go to retrieve the device.

For removal of superficial implants, report 20670 (Removal of implant; superficial [e.g., buried wire, pin or rod] [separate procedure]). In addition to the devices included in the code's descriptor, 20670 is also the correct choice for arch bar removal, says Aviva Mrazik, CPC, office manager for Jack A. Mrazik, DDS, in Hampton, VA.

When you deal with removal of bone plates, the level of the implant moves from superficial to deep, and the code must also shift from 20670 to 20680 (... deep [e.g., buried wire, pin, screw, metal band, nail, rod or plate]).

While the above codes apply to internal fixation devices, CPT also gives you an option for reporting removal of an external fixation system. In this case you would use 20694 (Removal, under anesthesia, of external fixation system).

As any OMS coder knows, correct coding doesn't necessarily equal reimbursement. "No matter how correct we try to be in our coding, we can still have great difficulty getting paid," Mrazik says. But in the case of removing fixation hardware, it is worth your effort to fight off nonpayments.

Cost: Here's the national average payment for each of the removal codes, based on Medicare's fee schedule:

• 20670: $491.65 nonfacility or $149.41 facility total
• 20680: $459.81 nonfacility or $276.03 facility total
• 20694: $434.85 nonfacility or $322.34 facility total

Reality: Many oral and maxillofacial coders frequently encounter device removal in conjunction with fracture care. If you come across these procedures performed under other conditions, however, you need to look carefully at the device application code before reporting removal.