Is excision of exostosis included with hardware removal?


I would like your advice on how you all would bill the below scenario.  My provider wants to bill both 20680 and 27635.  There are no NCCI edits with these 2 codes.  But my gut is telling me that these are bundled. 

An incision made over the medial malleolus.  Dissection was carried on through the skin and soft tissue.  Large exostosis was identified on the medial malleolus.  This was covering the screws.  This was removed and contoured to a smooth contour.  This was removed with an osteotome mallet and a rongeur.  This completed the partial excision of the right tibia

 I then used a broken screw removal set to remove the screws in the medial malleolus.  The screws were stripped.  This was a difficult removal.  I was able to remove both screws with the reverse cutting cone.  This completed the hardware removal right tibia.

Thank you!


  • Per an AMA inquiry, the removal of bony elements is included in the procedure and is therefore not reported separately. Maybe modifier 22 could be applied if supported. 
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