Removal of hardware

This is from the AAOS June 2004 Bulletin which is available on their website in the archives:

Hardware removal

Q: The patient had a bimalleolar ORIF and, for whatever reason, a year or two later the physician removes the hardware. There are two plates and eight screws (four screws in each plate). Do you report:

• 20680x10 for the two plates and eight screws?

• 20680 just once because it is considered one internal device that was placed?

• 20680x2 because you made two incisions to remove?

A: Based on a discussion by the AAOS ICD-9 and CPT Coding Committee, removal of hardware used for a specific fracture type—regardless of the number of screws, plates, rods or incisions—would only be coded once. If there was an extraordinary of work involved (e.g., bone-buried screws, exceptional scar), then modifier -22 would be added with the usual accompanying note.

Multiple use of 20680 would only be appropriate when the hardware removal was for another fracture unrelated to the first fracture (e.g.,ankle and humerus). Then modifier -59 would be used.