cpt code and description

20680 – Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate) – average fee amount-$600 – $650

20670 – Removal of implant; superficial (eg, buried wire, pin or rod) (separate procedure) average fee amount – $400

20680  Removal of implant; deep (e.g., buried wire, pin, screw, metal band, nail, rod or plate). 

For Procedure  code 20680, the RUC agreed that the intra-operative time for this code is misvalued based on the significant changes in physician work for the removal of deep implants due to changes in technology. Using the survey’s 25th percentile value for the work RVUs along with the 25th percentile value for intra-service time, and adjusting for the fact that this procedure is typically performed in an outpatient setting, the RUC recommended a work RVU of 5.86 for this service.

The RUC-recommended valuation for these Procedure  codes was as follows: 20680 = 5.86 work RVUs; 24430 = 14.00 work RVUs; 27465 = 17.50 work RVUs; 27470 = 16.05 work RVUs; and 27709 = 16.50 work RVUs.

Hardware Removals Use code 20680 for Deep Pin Removal procedures, where the physician makes an incision overlying the site of the implant dissects deeply to visualize the implant (which is usually below the muscle level and within bone), and uses instruments to remove the implant from the bone. The incision is repaired in multiple layers using sutures, staples, etc. Superficial pin or K-wire removals not requiring a layered closure (such as K-wire removals) are billed with code 20670.

When to Report the CPT Codes for Removal of Hardware Multiple Times

The June 2009 CPT Assistant has clarified when to report the removal of hardware CPT  codes multiple times. It is only indicated when fixation device(s) are removed from separate fractures at different anatomical sites or for two fractures that are considered noncontiguous on the same bone (such as a proximal and distal fracture site).

One example shows that it would be appropriate to report 20680 and 20680-59 for a bimalleolar fracture when screw(s) are removed from the lateral malleolus (distal fibula) and then a plate with screws are removed from the medial malleolus (tibia) through a separate incision. It doesn’t matter what type of implant system was removed the deciding factor was that it was two different fracture sites.

An example of incorrect use would be reporting code 20680 twice when an intramedullary rod (IM rod) is removed. This usually cannot be accomplished through one incision since there are locking screws on both ends of the rod so stab incisions are made proximal and distal to release the screws – this is still considered a single implant system for fixation of one fracture site. CPT code 20680 would only be reported once in this case.

20670 Removal of implant; superficial, (eg, buried wire, pin or rod) (separate procedure)

20680 Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)

Medically Unlikely Edits (MUEs)

The code descriptors for CPT codes 20670 (removal of implant; superficial…) and 20680 (removal of implant; deep…) do not define the unit of service. CMS allows one unit of service for all implants removed from an anatomic site. This single unit of service includes the removal of all screws, rods, plates, wires, etc. from an anatomic site whether through one or more surgical incisions. An additional unit of service may be reported only if implant(s) are removed from a distinct and separate anatomic site.

Question: I am new to oral surgery coding and would like to know how to report this procedure. Our oral surgeon  recently removed a previously implanted plate and screws using an intraoral approach. The patient had earlier suffered from a fracture of the body of the mandible on the right side. What CPT® codes should I report for this procedure? Also, do let me know how many units of the code should be reported (one for each screw and one for the plate or just one code)? 

Answer: You will have to report the CPT® code 20680 (Removal of implant; deep [e.g., buried wire, pin, screw, metal band, nail, rod or plate]) for the removal of the implanted plate and screws.

You will just have to report the removal code once, irrespective of the number of screws and plate that your surgeon removed from the fracture site. You have to just report one unit of the code even if your clinician removed the implanted hardware from the site using different incisions.

So, in your case scenario, you will only have to report one unit of 20680 for the procedure or else your claim will be denied.

Reminder: If your clinician were to remove the implants from two different sites (mandible and the zygomatic arch) and one fracture was not related to the other, then you can report the multiple removal using 20680 and 20680 with the modifier 59 (Distinct procedural service) appended to the second unit. Provide documentation to identify that both the fractures were in
different sites and not linked to one another.

To tell if you should use one unit or two, look at the fracture care codes and check “if they are the same” If they’re different, you may report two units, if the implants are not all parts of the same fixation device.

The hardware has to be two independent entities; otherwise, you should consider this one fixation device and one unit of 20680.

• Hardware Removals
Use code 20680 for Deep Pin Removal procedures, where the physician makes an incision overlying the site of the implant dissects deeply to visualize the implant (which is usually below the muscle level and within bone), and uses instruments to remove the implant from the bone. The incision is repaired in multiple layers using sutures, staples, etc.
Superficial pin or K-wire removals not requiring a layered closure (such as K-wire removals) are billed with code 20670.
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 the 20680 code 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.
* Removal of Hardware from Ankles has its own procedure code, code 27704 for the Removal of an Ankle Implant, which should be used instead of the 20670 or 20680 codes. However, if only one or two screws are removed and it is not an extensive
procedure, use the applicable 20670 or 20680 code, instead, as the 27704 code is for a more involved/extensive procedure.
* Removal of a Finger or Hand Implant should be billed with the 26320 CPT code. 
However, if only one or two screws are removed and it is not an extensive procedure, use the applicable 20670 or 20680 code.
* Removal of an Implant from the Elbow or Radial Head should be billed with codes 24160-24164. However, if only one or two screws are removed and it is not an extensive procedure, use the applicable 20670 or 20680 code.

Respondent’s Position Summary: “The current dispute involves the provider changing Procedure  codes from 26320 to 20680. The
procedure was pre-authorized and paid under Procedure  code 26320. Carrier did not authorize the change in Procedure  codes or the increase in the payment. The carrier denies that the provider has established pre-authorization for Procedure  20680. Carrier maintains its position.

Review of the CMS-1500 documents the requestor billed for Procedure  Code 20680-F7, not the preauthorized Procedure  Code 26320. 

Per 28 Texas Administrative Code §134.600, the disputed service required preauthorization. The requestor submitted insufficient documentation to support that preauthorization was requested and obtained for disputed Procedure  Code 20680- F7. As a result, the medical fee dispute resolution section determined that reimbursement couldn’t be recommended for the dispute service.

Review of the CMS-1500 documents the requestor billed for Procedure  Code 20680-F7, not the preauthorized Procedure  Code 26320.

Per 28 Texas Administrative Code §134.600, the disputed service required preauthorization. The requestor submitted insufficient documentation to support that preauthorization was requested and obtained for disputed Procedure  Code 20680-F7. As a result, the medical fee dispute resolution section determined that reimbursement couldn’t be recommended for the dispute service.

Review of the submitted documentation finds that the requestor is not entitled to reimbursement for disputed Procedure  code 20680-F7 rendered on August 18, 2015.