Wiki Modified McBride with screw removal

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katiejeanne

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Patient presents with a hallux valgus and painful hardware (screw) of the left foot. The surgeon does a Modified McBride bunionectomy with removal of hardware. He filled in the previous holes with bone putty. The surgery dept wants to also code 20680 for screw removal in addition to the 28292 for the bunionectomy. I am questioning this...is the screw removal included in the bunionectomy code? I am having trouble finding the answer to this but it seems like it would be. Please help! Thanks!

Katie, RHIT
 
katiejeanne said:
Patient presents with a hallux valgus and painful hardware (screw) of the left foot. The surgeon does a Modified McBride bunionectomy with removal of hardware. He filled in the previous holes with bone putty. The surgery dept wants to also code 20680 for screw removal in addition to the 28292 for the bunionectomy. I am questioning this...is the screw removal included in the bunionectomy code? I am having trouble finding the answer to this but it seems like it would be. Please help! Thanks!

Katie, RHIT
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not in CCI edits
 
From Chapter 4 of the NCCI Guidelines:

"8. There are CPT codes (20670 and 20680) for removal of internal fixation devices (e.g., pin, rod). These codes are not separately reportable if the removal is performed as a necessary integral component of another procedure. For example, if revision of an open fracture repair for nonunion or malunion of bone requires removal of a previously inserted pin, CPT code 20670 or 20680 is not separately reportable.
Similarly, if a superficial or deep implant (e.g., buried wire, pin, rod) requires surgical removal (CPT codes 20670 and 20680), it is not separately reportable if it is performed as an integral part of another procedure."

I don't know if the hardware removal is an 'integral part' of the 28292 in this case; however, unless the surgeon made a separate incision - at a different site - to remove the hardware, I wouldn't code separately.
 
Are you only reporting 28292 and not 28306-59 (See CPT Assistant December 2010) For Modified McBride it should be reported as 28292, 28306-59. :)
 
I found that CPT Assistant article and read through it. No osteotomy was performed in the one I am coding (as indicated in that article) so I am not going to use 28306.
I did query the surgeon to see if it was an "integral part" and he said that it was not required for him to remove the screws in order to perform the McBride procedure. So according to him it is necessarily part of the bunionectomy procedure. I think I will go ahead and code it out separately after talking with him. I'll cross my fingers! Thanks everyone.

Katie, RHIT
 
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