Wiki Screw removal x 2

klienhart

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I have a question regarding the below surgery.

The provider removed and replaced 2 screws (20680-22). A screw was removed and replaced from the syndesmotic disruption and a screw was removed from the lateral malleolar fracture through the Same incision. Since it was two fracture, same incision, can I bill 20680-22 once or twice?

The previous incision was opened. The syndesmotic screw was identified. It was removed without too much difficulty. Drill holes were made in another direction, and attempts were made to pass the screw, but it was impinging on the screw entering from the medial side to stabilize the plate, and therefore again the direction was changed, and another screw was placed. This appeared to be too long and therefore was changed to the appropriate length, and compression was obtained at the syndesmotic screw with ankle in dorsiflexion.

Further exploration revealed that the proximal of the distal lateral malleolar locking screw was also backing out; therefore, it was removed. It was measured again, and the length was 12, and the screw was 14 mm. Because of this, there was not much bone in the lateral malleolus, and this was therefore packed with small chips of cancellous bone obtained from the back. A 12-mm fully threaded cancellous screw was placed and it appeared to have good purchase on the bone.

The wounds were irrigated out and then closed in layers using 2-0 Vicryl for the subcutaneous fat and staples for the skin. Pressure dressing was applied. The patient's leg was immobilized in a cast. On release of tourniquet, there was brisk return of circulation, and the patient was discharged home in satisfactory condition.
 
I would refer you to the NCCI Policy Manual Chapter IV - I would say no this could not be billed twice, same incision; however, I question since the screws were replaced if you shouldn't be coding that vs the removal. Obviously, you can't bill both, but it reads like there was much more work than removing the screws.
 
Per the NCCI Surgical Policy Manual you can't bill the removal at all. You would never bill 20680-22 or 20680 X 2 if the hardware is taken from the same anatomical location.
 
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