Wiki 20680 - Downcoding to 20670

[ngomezz]

Hi there,
Can someone please help me with our constant downcoding of 20680 to 20670.
I work for hand surgeons that constantly pull kwires and/or plates from fingers and/or wrists. We are constantly getting downcoded and they are referencing the AAPC having a specific description that allows the downcode. I am wanting to find out if we should be billing the 20670 instead of 20680.

Thank you!

 

[HReed]

What is the actual closure that is being performed for these procedures? The act of "pulling" would imply the code of 20670. 20680 requires a layered closure.

 

[NRaizman]

If it is sticking out of the skin or close to it, it is 20670.

Beyond that, I would recommend that your hand surgeons, to avoid any confusion, clearly describe dissection deep to skin/subcutaneous tissue, either to/through fascia or muscle, down to bone, where the pin is identified and extracted. CMS, CPT nor any other authority define "superficial" and "deep" in this context and it is up to the surgeon to be clear for the purposes of avoiding confusion or auditing.

20680 does not, in any way, shape or form, require a layered closure. That guidance is incorrect and is not based on either the code descriptor, CPT-A, NCCI policy, nor GSD. The vignette for 20680 may have described a layered closure, but that is merely an example "typical" case and does not imply a requirement, nor does it ever.