Podiatry Coding & Billing Alert

Every podiatry coder knows the tools of the podiatrist’s trade, from casts and splints to orthotics. But one essential supply that many podiatrists use is called Kirschner wire, known as K-wire for short. And if you don’t understand when you can and can’t code for removing this wire, you could be losing money.

Check out a few important facts about coding for K-wires so you can master this confusing topic every time your podiatrist’s operative notes include them.

Include K-Wire Insertion in Most Surgeries

When the podiatrist uses K-wire to stabilize a foot issue, it’s considered the stabilization or fixation portion of the procedure. Because the global surgery package for the surgical procedure itself typically includes payment for stabilization/fixation, you won’t report K-wire insertion separately in almost every case.

For instance, during a hammertoe correction, the podiatrist may remove parts of the toe bones, cut or transplant the toe tendons, and fuse the joint so the toe is straight. They will then typically use K-wire to keep the toe bones in place so they don’t fall out of place during the healing process. The patient may be asked to stay off the foot, or to use special shoes so the hammertoe correction can heal properly while the K-wire remains in place. In this situation, you’ll report the appropriate hammertoe surgery code (typically 28285, Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)). No additional code should be reported to reflect the K-wire insertion

In black and white: CPT^® Assistant addressed this issue in the March 2015 issue, noting, “Insertion of K-wire through DIP, PIP, and MTP joints are all inclusive components of the procedure described by code 28285, and should not be reported separately.”

Know When K-Wire Removal Is Billable

After the patient heals, the podiatrist will typically remove the K-wire during a postsurgical office visit. In the vast majority of cases, this removal is included in the procedure itself and is not separately billable. But “if you feel the notes support charging for this in office, be sure to include them with your claim to avoid having to do an appeal later,” suggests Jeri L. Jordan, CPC, billing manager at Hampton Roads Foot and Ankle in Williamsburg, Virginia.

In rare cases, however, the K-wire is not easily removed because it was cut and ended up getting buried deep within the skin. In these situations, you may have to return the patient to the operating room (OR) to remove the K-wire, in which case, you can report 20680 (Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)) for the procedure. You’ll also have to append modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period) to tell the insurance company it was necessary to do a second procedure on the patient, which necessitated a return to the OR.

Another situation when K-wire removal may be separately billable is if you’re seeing a patient who had a previous surgery in which K-wire was inserted, but which was unsuccessful. If you need to remove previously placed K-wire to restabilize a patient, you can report 20680, according to the September 2012 edition of CPT^® Assistant. And you’ll bill superficial pin or K-wire removals not requiring a layered closure with 20670 (Removal of implant; superficial (eg, buried wire, pin or rod) (separate procedure)), Jordan notes.