Regarding pin removal in office while still in post op

[rjenn86]

I am wondering if I should be billing out cpt code 20670 for pin removal in the office during pt's post op period that is related, in the past I have been but just happened to run across something that states you cannot, if it is related, unless taken to the OR. Is this correct? Should I not be billing out cpt code 20670 with mod 58 when done in the office. Thank you for you help !!

 

[jdemar]

You have to take the pt. to the O R to be able to bill for removal of hardware in the post op period with a 58 modifier in this case. ( or 78 if applicable.)

 

[edeschaine]

20670 in the office or included in 26850

can the provider perform 20670 in the office or does it have to be in the OR?
same question regardless if it is inside the global period, or outside of it.

inquiring minds want to know.
thanks

 

[CaroleF01]

You have to take the pt. to the O R to be able to bill for removal of hardware in the post op period with a 58 modifier in this case. ( or 78 if applicable.)

Is there a reference for this?? I keep reading this answer in different places but I have not found it in writing so that my surgeon will be satisfied. :-/

 

[thomas7331]

Is there a reference for this?? I keep reading this answer in different places but I have not found it in writing so that my surgeon will be satisfied. :-/

The CMS booklet, link below, is the best reference I know of for this. See page 6-7 which lists the services that are and are not included in the global surgery surgery payment. Also, the requirements for the use of modifiers 58 and 78 are listed beginning on page 13.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/GloballSurgery-ICN907166.pdf

 

[CaroleF01]

The CMS booklet, link below, is the best reference I know of for this. See page 6-7 which lists the services that are and are not included in the global surgery surgery payment. Also, the requirements for the use of modifiers 58 and 78 are listed beginning on page 13.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/GloballSurgery-ICN907166.pdf

Funny - I was just in there hoping it would specifically state 'pins' but it does not. I states Miscellaneous services, such as dressing changes, local incision care, removal of operative pack, removal of cutaneous sutures and staples, lines, wires, tubes, drains, casts, and splints; insertion, irrigation, and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal tubes; and changes and removal of tracheostomy tubes.

For modifier 58 -- I don't see how it does not support billing for pin removal in the office other than the fact that it starts a new post-operative period. That would perhaps lead one to infer that the second procedure was as weighted as the first??

 

[thomas7331]

For modifier 58 -- I don't see how it does not support billing for pin removal in the office other than the fact that it starts a new post-operative period. That would perhaps lead one to infer that the second procedure was as weighted as the first??

Per my understanding of modifier 58, the pin removal procedure would need to have been planned in advance of, or at the time of the original procedure to meet the first definition of a 'staged' procedure (since it does not meet either of the other two definitions). Otherwise, if it is a related procedure or due to a complication that doesn't require a return trip to the operating room, it would be part of the global package.

 

[CaroleF01]

Per my understanding of modifier 58, the pin removal procedure would need to have been planned in advance of, or at the time of the original procedure to meet the first definition of a 'staged' procedure (since it does not meet either of the other two definitions). Otherwise, if it is a related procedure or due to a complication that doesn't require a return trip to the operating room, it would be part of the global package.

True -- I was making an assumption that it would have been planned in advance. I guess that would be the fine line between staged and inherent. I agree that the work performed doesn't really support billing the 20670,58 done in the office. My surgeon can be hard headed when he thinks he is right ... I know, that's a shocker! lol

 

[klienhart]

If the pins are removed in the office, 20670, during global, they are not billable, they are part of the global package. If the surgeon takes the patient to the OR for pin removal, then they can be billed with modifier 58.

 

[golymom]

If the pins are removed in the office, 20670, during global, they are not billable, they are part of the global package. If the surgeon takes the patient to the OR for pin removal, then they can be billed with modifier 58.

We keep seeing that the superficial pin removal done in the office during the global cannot be billed but I have not found a single reference to support this stance. There is nothing in the code description that indicates it has to be done under anesthesia like the fixator removal. The separate procedure designation is only applicable for procedures performed at the same encounter. It would require a 58 modifier if during a global period with documentation to support that this was planned but otherwise I find nothing official. There is nothing in CCI. There is nothing in CPT Assistant. There is nothing in the CPT guidelines or code description including in those codes that define being performed with percutaneous fixation. I only find information that has been passed down to us for many years. For those who are insisting this is not billable, please provide your official resource. ASSH is firm that hardware removal in the office is indeed separately reportable during the global period for the reasons stated.

 

[NRaizman]

We keep seeing that the superficial pin removal done in the office during the global cannot be billed but I have not found a single reference to support this stance. There is nothing in the code description that indicates it has to be done under anesthesia like the fixator removal. The separate procedure designation is only applicable for procedures performed at the same encounter. It would require a 58 modifier if during a global period with documentation to support that this was planned but otherwise I find nothing official. There is nothing in CCI. There is nothing in CPT Assistant. There is nothing in the CPT guidelines or code description including in those codes that define being performed with percutaneous fixation. I only find information that has been passed down to us for many years. For those who are insisting this is not billable, please provide your official resource. ASSH is firm that hardware removal in the office is indeed separately reportable during the global period for the reasons stated.

Agreed. AAOS, ASSH and KZA all confirm that, except in specific cases where the code descriptor notes that hardware removal is included, all hardware removal is separately reimbursable with appropriate modifiers, and this is irrespective of site-of-service. There are no NCCI Edits, CPT-A guidance, RUC vignettes, GSD or CMS guidance that would suggest otherwise.