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!
Anna Weaver, CPC, CPMA, CEMC