RT Welter & Associates is excited to present our monthly Code Spotlight! Each month, RT Welter & Associates will spotlight a unique CPT or ICD-10 code to profile and discuss practice applications of the code, as well as pertinent guideline reminders.
CPT Code 20680 — Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod, or plate)
CPT code 20680 requires the provider to incise through muscle layers and into the bone, necessitating a more complex, layered closure. The physician makes an incision overlying the site of the implant using deep dissection to visualize the implant (usually below the muscle level and within bone), using instruments to remove the implant from the bone. The physician repairs the incision in multiple layers using sutures, staples, etc. CPT Assistant and the AAOS (American Academy of Orthopedic Surgeons) direct that the 20680 code is to be billed once per fracture site, rather than based on the number of pieces of hardware removed or the number of incisions made to remove the hardware from one fracture site or original area of injury. Billing 20680 more than once is only appropriate when hardware removal is performed in a different anatomical site unrelated to the first fracture site or area of injury. It is fraudulent to send a patient to the OR/ASC for the sole purpose of seeking reimbursement for 20680, when medical necessity is not supported.