Is excision of exostosis included with hardware removal?

Kestrelwa

Contributor
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Hi,

I would like your advice on how you all would bill the below scenario. My provider wants to bill both 20680 and 27635. There are no NCCI edits with these 2 codes. But my gut is telling me that these are bundled.

An incision made over the medial malleolus.  Dissection was carried on through the skin and soft tissue.  Large exostosis was identified on the medial malleolus.  This was covering the screws.  This was removed and contoured to a smooth contour.  This was removed with an osteotome mallet and a rongeur.  This completed the partial excision of the right tibia

I then used a broken screw removal set to remove the screws in the medial malleolus.  The screws were stripped.  This was a difficult removal.  I was able to remove both screws with the reverse cutting cone.  This completed the hardware removal right tibia.

Thank you!
 

Orthocoderpgu

True Blue
Local Chapter Officer
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953
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Salt Lake City, UT
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In this situation, no

Code 20680 includes anything that is needed to do in order to get the hardware out.

In this case the exostosis was covering the screw that the physician wanted to remove. The removal of this bone in order to get out the screw is included with 20680.

You could consider modifier -22, but the documentation would need to support it. And I have had surgeries where removing the bone formation from around plates took quite a while, so this may be something you can educate your physician about so that it can be documented in the future.
 
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