I would disagree with the previous response to this query. If the
only procedure done was
Removal of the screw that was too long, then 20680 would be correct, but the descriptor for 20680
does not include Replacement with another screw.
There is a lot of missing information about this case such as the time line for when the patient was originally injured and had her index procedure. If it was recent enough that the fracture had not healed completely, and was still in the healing process, then this procedure would qualify as a
Revision ofthe Open Treatment of the Tibial Plateau Fracture with Internal Fixation, 27535 (assuming this was a unicondylar fracture). CPT doesn't really address "Revision of Internal Fixation" as an identifiable procedure as it does for Joint Prostheses/Arthroplasties of the Knee and Hip, where there are specific codes. Therefore, in this situation, one would have to consider this
"Revision" to be a
"Repeat" of the original procedure, 27535,
if the fracture was still sufficiently acute/subacute so as to still be healing, and the screw fixation was still necessarily to maintain the stability of the fracture reduction/alignment. If this is the case, then he could have used the 27535 code again
with the
77 Modifier: Repeat Procedure by Another Physician.
Hopefully the preoperative and postoperative
diagnosis codes for this case are determined and listed so as to "justify" this "Revision/Repeat" procedure, i.e. what symptoms/complaints by the patient, pertinent physical and X-ray findings etc. are documented that indicate that this particular "too long screw" is a clinical problem warranting its removal and replacement.
By accepting the 20680 procedure alone, I believe the surgeon is "shorting" himself in the care of this patient.
Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com