CPT 20680 : Removal of internal fixation/ implant

Removal of Hardware [Sample Image]

Removal of internal fixation/ implant-

Code 20680 describes a unit of service that is typically reported only once, provided the original injury is located at only one anatomic site, regardless of the number of screws, plates, or rods inserted, or the number of incisions required for removal.

The removal of a single implant system or construct, which may require multiple incisions (eg, intramedullary [IM] nail and several locking screws) is reported only once with code 20680.

Reporting code 20680 more than once is appropriate only when the hardware removal is performed for another fracture(s) in a different anatomical site(s) unrelated to the first fracture (eg, ankle hardware and wrist hardware).

In these circumstances, modifier 59, Distinct Procedural Service, would be appended to subsequent uses of the implant removal code. Removal of two different and noncontiguous implants from two different bones using separate incisions (eg, radius and ulna) may be reported twice by using code 20680.

Likewise, removal of two different implants from noncontiguous sites on the same bone (eg, tibial plateau and medial malleolus) using separate incisions may also be reported twice with code 20680.

Depending on whether the implants were superficial or deep, code 20670 and/or code 20680 may be reported more than once.

If there was an extraordinary amount of work or unusual effort involved in the hardware removal (eg, screws buried in bone or an exceptional amount of scarring), then modifier 22, Increased Procedural Services, may be appended to the code for the procedure. Documentation that supports the substantial additional work and the specific reason(s) for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient’s condition, physical and mental effort required), must be provided