CPT ASST June 2009 reads:
Removal of Deep or Superficial Bimalleolar Plate and Screws
Code 20680 would be used to describe the removal of a plate (eg, periarticular plate, locking plate, or one-third tubular plate) and screws from the fibula in a healed bimalleolar ankle fracture. If deep buried medial malleolar screws are removed from the tibia's medial malleolus at the same session, use code 20680.
If removing superficial screws from the fibular fracture, code 20670 should be reported. If superficial screws are removed from the tibia's medial malleolus at the same session, the procedure is reported using code 20670 with modifier 59 appended.
Multiple use of code 20680 would be appropriate only when the hardware removal was performed for another fracture in a different anatomical site unrelated to the first fracture (eg, ankle and humerus). In these circumstances, modifier 59, Distinct procedural service, would be appended to subsequent uses of the code. For example, two different and noncontiguous implants are removed from two different bones or two different (noncontiguous) sites on the same bone using multiple incisions. Depending on whether the implants were superficial or deep, code 20680 may be reported twice or codes 20680 and 20670, Removal of implant; superficial (eg, buried wire, pin, or rod (separate procedure), may each be reported.