Partial removal of deep hardware


Lees Summit, MO
Best answers
Patient suffered a crush injury to right leg resulting in disruption of popliteal artery, traumatic compression syndrome, and comminuted fracture of tibia. Subsequent to treatment of same, including ORIF of tibia, the patient developed gangrene/necrosis of the foot extending to the lower one third of the leg. Decision was made to perform a partial amputation; this included cutting through and removing the distal portion of the tibial plate and screws. Is the hardware removal separately billable, perhaps with a 52 modifier, or part and parcel of the amputation? I'm leaning towards the latter. Your thoughts/advice are much appreciated.

check cci edits to see if the 20680 is allowed with whichever CPT you are using for the amputation. There would be no need to reduce the service for the hardware removal because it doesn't matter if it was 1 screw or 10, its still the same code.
Just an FYI, as it turns out, even though the codes are not bundled per CCI edits, the CCI policy manual states cdoes 20670 and 20680 "are not separately reportable if the removal is performed as a necessary integral component of another procedure" (Chapter 4 Version 13.3, pg 5). Guess I should've checked there first!