Hardware removal ankle fx

Hello-I have a doctor that has questioned billing 20680 x2 for a bimal/trimal hardware removal and I have given him the info stating it would only be billable once. However he has sent me the 2009 CPT assistant where it does state a bimalleolar fx would be billed x2 if the hardware is removed through separate incisions from the tib and fib.......is there any other info out there to dispute this? Everything else I am finding basically states 1 code to put it in 1 code to take it out. Thanks for any input!


  • Hello - May 2016 Orthopedic Coder's Pink Sheet says, "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 (e.g., ankle and humerus)." the AMA says. So even if a surgeon must do multiple stabs or incisions to remove a single implant system such as an intramedullary rod with proximal and distal interlocking screws, you would still only report one unit for 20680, AMA says.

  • Thank you!!! I thought there was additional info out there just couldn't find it. Have a great weekend!
  • Totally disagree.  The reference is for a a bimalleolar is not a single fracture is it a single diagnosis and CPT code but it involved two different bones.  The reference was so that multiple hardware removals weren't being charged because of multiple screws being place in a single plate or single bone.  There is a reference in a 2009 CPT Assistant below which states that if the fixation is not contiguous or different bones multiple units of 20680 may be billed.  There is also a reference for this specifically relating to a bimalleolar but I can't find it right now.

    "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."

  • I did see that CPT assistant however isn't there more recent information which stated only billable once and something like "1 code to put in 1 code to take out" I know I saw that somewhere but can't find it for the life of me.
  • I found this from Margie Vaught-AAOS article-did something change? "
    Hardware removal
    Q: The patient had a bimalleolar ORIF and, for whatever reason, a year or two later the physician removes the hardware. There are two plates and eight screws (four screws in each plate). Do you report:
      • 20680x10 for the two plates and eight screws? • 20680 just once because it is considered one internal device that was placed? • 20680x2 because you made two incisions to remove?
    A: Based on a discussion by the AAOS ICD-9 and CPT Coding Committee, removal of hardware used for a specific fracture type—regardless of the number of screws, plates, rods or incisions—would only be coded once. If there was an extraordinary of work involved (e.g., bone-buried screws, exceptional scar), then modifier -22 would be added with the usual accompanying note.

    Multiple use of 20680 would only be appropriate when the hardware removal was for another fracture unrelated to the first fracture (e.g.,ankle and humerus). Then modifier -59 would be used"

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