Wiki HARDWARE REMOVAL WITH OTHER PROCEDURES

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RebeccaMoney

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When can hardware removal be billed with other procedures? Encoder Pro shows that there are no CCI conflicts with CPT 24149,24420, & 20680 . However, 20680, is denied as inclusive. Is hardware removal only billable if through a separate incision? I believe the only reason the hardware is being removed in this particular surgery is for pain not to complete another procedure. There is no separate incision. Can anyone please comment?
thank you,
 
Just cause it does not hit an edit does not mean its billable. As a general rule any hardware that is in the same surgical field or anatomical area of another procedure is generally not billable. Are we splitting hairs? Yes! Before an insurance company pays for hardware removal they will want to see "clear separation" of the procedures. Meaning separate incision or different body area or joint. 24149 is also a "Separate Procedure". Was 20680 performed through the same incision? If so, I would rather have 24149 paid rather than just 20680. Not going to pay both with a separate procedure. You mentioned that the hardware was removed for pain and was not necessary to remove in order to perform the other procedures. I would speak with your surgeon and verify that and even get more specific information. If after speaking to your surgeon you feel it should be paid, send in an appeal with the information you get from your physician. To be honest it would be a long shot. It may actually qualify to be billed separately, but getting the insurance to pay for it is another story.
 
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