screw reinsertion of prior arrest, epiphyseal

There is debate in how to code for reinsertion of the screw into the plate of the prior arrest, epiphyseal?  Would you code 27485, 27485-52, or an unlisted code.  The provider is only replacing the prior removed screw so does this support billing 27485?  How are you all billing for this service. 

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  • Here is description of one of the surgeries I am looking at   

    Following induction of general anesthesia in the supine position, both legs were prepped and draped in a sterile fashion. The right side was done first. No tourniquet was used. The image intensifier was centered over the distal femur. The trajectory of the metaphyseal screw was marked on the skin. At that level, through the medial surgical scar, a 2 mm incision was made. This was injected with quarter percent Marcaine with epinephrine. The guidepin was inserted into the metaphyseal screw was removed with the cannulated screwdriver, leaving the plate and epiphyseal screw intact for future reference. The wound was irrigated and closed with horizontal mattress suture of 4-0 Monocryl.

    The image intensifier centered over the left distal femur. The trajectory of the proposed metaphyseal screw was marked on the skin. At that level through the medial incision and 2 mm incision was made. This was infiltrated with quarter percent Marcaine with epinephrine. The guidepin was placed into the vacant metaphyseal hole in the plate, checking its position with the image intensifier. The cannulated 32 mm x 4.5 mm screw was placed over the guidepin and firmly inserted into place whereupon the guidepin was removed. The wound was closed with horizontal mattress suture of 4-0 Monocryl. The identical procedure is carried out upon the opposite side.

  • HCPCS CC 1st Qtr 2010 reference: QUESTION #15
     
    A patient who underwent an ankle fusion previously was seen at our facility with areas of localized tenderness of the medial ankle. Work-up revealed a prominent screw head as the cause of the localized tenderness. A decision was made to remove the screw and exchange it with a shorter screw. What are the appropriate code assignments for this scenario?
     
    ANSWER
     
    Presently, there is no CPT code for exchange of hardware. Therefore, report CPT code 20680, Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate, for removal of the screw from the medial ankle. CPT code 27899, Unlisted procedure, leg or ankle, would be reported for the insertion of the shorter screw.
     
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