This is from an AAOS Bulletin:
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:
â€¢ 20680x10 for the two plates and eight screws?
â€¢ 20680 just once because it is considered one internal device that was placed?
â€¢ 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 typeâ€”regardless of the number of screws, plates, rods or incisionsâ€”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.
Per this description, the lysis of adhesions might warrant attaching Modifier 22 to 20680. I don't see synovitis anywhere in your original post, so I wouldn't consider 26135.
Any other opinions on this?
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