Wiki Removal and Replacement of Plate in Mandible

[MaryBethCPC]

Hello!

We have a patient with a plate used to repair an avulsive injury (plate was placed by another surgeon) that has now become displaced and infected. My doctor (oral surgeon) needs to remove the plate and replace with a new one. He stated that it is like an open reduction internal fixation of the mandible, but I feel like open treatment of mandibular fracture would not be the best code as the injury itself is healed; it is the infected, mobile plate causing the issue. I have looked, but have not found something else that seems to fit this exact situation. Anyone have any ideas on the best CPT code?

Thanks!
Mary

 

[ksobota]

I've seen a couple of different ways to do this in researching for a surgeon of ours a long time ago.

First is 20680-22 and submit with notes. The other I have seen is to use 20680 for removal and the 21499 (unlisted musculoskeletal procedure, head) in this instance for the replacement and submit with notes.

We've also had a another patient who had a fused wrist, fell, broke the plate. The doc did removal and fused again so we were able to bill the two separate procedures based off of his dictation. Do you have the dictation available? Or are you just trying to pre-auth something?