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coding 20670 in post op period

  1. #1
    Default coding 20670 in post op period
    Medical Coding Books
    Our hand surgeon will bill 20670 (removal of superficial implant) when he removes pins in the office on a patient in a postop visit. The pins were originally placed in the OR during the surgical procedure. Is 20670 billable? Normally he does not make an incision in order to remove the pins but just uses a pin puller and "easily" removes the pins. Thank you for your input.
    eguest, CPC

  2. #2
    Thats a NO NO (Shaking my finger) Its inclusive in the surgery if its being done in the office!! He can only capture the code if he takes the patient back to the OR.

  3. #3
    Milwaukee WI
    Default Coding vs Billing
    I respectfully disagree that it's a NO NO if it's performed in the office to CODE 20670. However, you can't BILL it to Medicare and get paid for it.

    That being said ... I still agree with Mary that pulling pins without an incision is NOT 20670. Here's the lay description:
    The physician makes a small incision overlying the site of the implant. The implant is located. The physician removes the implant by pulling or unscrewing it. The incision is closed with sutures and/or Steri-strips. (emphasis added by FTB)

    So if the surgeon is just pulling pins without any incision, I think it's part of the post-op care.

    F Tessa Bartels, CPC, CPC-E/M

  4. #4
    my response was based on the following documentation, page 2.

    American Academy of Orthopaedic Surgeons¬ģ Volume 6, Number 3 June 2005
    800-346-2267 and
    Code X-tra
    Medical record coding tips and conventions for subscribers to
    Orthopaedic Code-X Software
    Committee on Coding, Coverage, and Reimbursement
    M. Bradford Henley, MD, Chairman
    Richard Friedman, MD, Code X-tra Newsletter Editor
    Department of Health Policy and Practice - Robert Fine, Director
    Department of Electronic Media, Evaluation and CME Course Operations - Howard Mevis, Director
    The Centers for Medicare and Medicaid Services (CMS) will begin enumeration for the National Provider
    Identifier (NPI) on May 23. The NPI is the standard unique health identifier that must be used by covered
    entities under HIPAA to identify health care providers in standard transactions such as claims, referrals
    and remittance advices. The NPI must be used in standard electronic health care transactions and will
    replace different provider identifiers under various health plans. Transitioning to the NPI will begin this
    year and must be used on all standard transactions no later than May 23, 2007. CMS has issued a
    "Dear Health Care Provider" letter that describes how to obtain an NPI; to access this letter and links to
    additional information and application materials: (Acrobat Reader required)
    Return to Index
    Submitted by Mary LeGrand, RN,MA, CCS-P, CPC
    Activity Therapist
    Can we submit to Medicare charges for Physical Therapy if our Activity Therapist provides the
    No, you may not report therapeutic physical therapy services provided by the Activity Therapist (AT) to
    Medicare. Medicare does not recognize this level of provider as an appropriate source for this service.
    The AT may not report PT services incident-to the physician or incident-to a physical therapist.
    ¬© Copyright 2005, American Academy of Orthopaedic Surgeons¬ģ 2
    Instrumentation: Unilateral or Bilateral
    Can we use modifier 50 (bilateral) with 22842 since both sides may (or may not) be instrumented?
    No, the instrumentation codes are considered unilateral/bilateral procedure codes, thus may only be
    reported one time when the surgeon places one rod or bilateral rods.
    Modifier 25: Significant Separate Service
    When it is appropriate to use modifier-25 on the same day that you are also billing an injection or
    It is appropriate to report both the E&M with a modifier 25 and the minor surgical procedure when the
    E&M is either the significant or separate service on the same day as the minor procedure. To be the
    significant service, the work performed during the evaluation and management service must be more than
    the normal cognitive evaluation associated with the surgical procedure. This is typically the “decision for
    surgery‚ÄĚ E&M or the initial evaluation of the problem. To be the ‚Äúseparate‚ÄĚ service, the E&M must be
    performed for a problem unrelated to the minor surgical procedure.
    Pin Removal During the Global Period
    How do you bill for the removal of pins in the office setting during a global period when it is related
    to the procedure that is in post-op? (CPT code 20670)
    If the pins are removed in the office by the surgeon or partner, the removal is not separately reportable. If
    the pins are removed in the operating room, append the appropriate modifier (-58, staged procedure or -
    78, related procedure) to the pin removal assuming no other procedure is performed at the same site.
    Use of the Operating Microscope
    Can we charge 69990 when charging for 63012 because we use microscope in exposure?
    CPT code 69990 Use of Operating Microscope may be reported in addition to CPT code 63012,
    Laminectomy with removal of abnormal facets and/or pars inter-articularis with decompression of cauda
    equina and nerve roots for spondylolisthesis, lumbar (Gill type procedure) when the surgeon documents
    the use of the operating microscope for microdissection or microsurgical techniques. If the operating
    microscope is used only for magnification then 69990 may not be reported in addition to the CPT code
    63012. The physician must clearly document the work performed with the operating microscope.
    Joint Aspirations During the Global Period
    What modifier would you use to bill for aspiration of a hemarthrosis in the office setting when the
    patient is in the post-op period for that same knee? (CPT code 20610)
    First, we must know if the payor follows CPT rules or Medicare rules for the surgical package definition.
    Per Medicare, the aspiration of a hemarthrosis in the operative knee would not be separately billable
    unless the procedure is performed in the operating room.
    If the payor follows CPT rules, the physician must determine if the hemarthrosis is considered ‚Äútypical‚ÄĚ
    follow up care or not. If the payor determines this is separately reportable, request the payor provide
    written instructions on how to submit this procedure during the global period, including the use of
    modifiers, if any.
    Alert: Please check your 2005 HCPCS book or Medicare fee schedule for listings of current J codes for
    drugs. There is a HCPCS errata in Code- X related to J codes.
    Return to Index

  5. Question Cpc/slortho
    In response to whether to code (20670) in the office during a post op period. It seems to me that you could code this procedure since it is a "superficial" procedure & only carries a (10) day global period & stating that it should only be done in the "or" does this procedure justify the use of an operating room-facility chg-lab-anesthesia, etc. When it can be done in the office with a local anesthetic? I understand that medicare will not cover it but the other insurance carriers may cover this chg with a (58) mod code which is for a staged or related procedure during the post op period. Just my thoughts on this procedure.

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