Wiki Sternal wire removal 20680

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LLovett

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Is anyone aware of any carriers that want us to put units on 20680 to identify how many wires were removed?

I have never heard of this and when I questioned the company advising us to bill 7 units for 1 procedure because there were 7 wires, this is the response I got

"I do not have your carriers guidelines. Put one unit and be done with it. It was just put on there to indicate how many sterna wires were removed. I would have my biller put one unit and send the claim out the door."

My understanding was you would just report it once no matter how many wires were removed if they were all done at the same time. If I am wrong I would like to know. If this company is trying to be shady I would also like to know.

Thanks

Laura, CPC, CEMC
 
Hi Laura,
I read in a Plastic Surgery journal that you could bill for each wire removed BUT, the society of thoracic surgeons recommends only billing this code once regardless of how many wires removed. I only bill it once.

Lisi, CPC
 
Thanks Lisi.

That confirms what I have been able to find. I just can't justify billing it multiple times when they are only opening and closing once.

Laura, CPC, CEMC
 
20680

Here's what CPT assistant says:

Code 20680, Removal of implant; deep (eg, buried wire, pin, screw, metal band, rod or plate), describes a unit of service that is reported only once provided the original injury is located on one site, regardless of the number of screws, plates, rods or incisions. An example would be the removal of a single implant system, which may call for "stab" or multiple incisions (eg, intramedullary (IM) nail and several locking bolts).

Multiple use of code 20680 would be appropriate only when the hardware removal was performed for another fracture in a different anatomical site unrelated to the first fracture (eg, ankle and humerus). In these circumstances, modifier 59, Distinct procedural service, would be appended to subsequent uses of the code. For example, two different and noncontiguous implants are removed from two different bones or two different (noncontiguous) sites on the same bone using multiple incisions. Depending on whether the implants were superficial or deep, code 20680 may be reported twice or codes 20680 and 20670, Removal of implant; superficial (eg, buried wire, pin, or rod (separate procedure), may each be reported.

If there was an extraordinary amount of work, or unusual effort involved in the removal (eg, bone buried screws or an exceptional scar), then modifier 22, Increased procedural services, may be appended to the code for the procedure and submitted with the usual accompanying documentation.

Hope this helps!
 
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