I am looking for research resources. I review claims, and frequently see Orthopedic providers submitting CPT 20694 (removal of external fixation device, requiring general anesthesia) with an ORIF. I have performed exhaustive searches through my coding manual, the NCCI manual, AAOS Code-X, and Google to find any vetted research indicating whether or not this can be separately reported with an open definitive treatment code. The closest I have is this entry from the NCCI Manual regarding the removal of internal hardware at the same site as a surgical procedure, but I’m looking for something more specific:

National Correct Coding Initiative Policy Manual for Medicare Services

CHAPTER IV SURGERY: MUSCULOSKELETAL SYSTEM

G. Fractures, Dislocations, and Casting/Splinting/Strapping

10. There are CPT codes (20670 and 20680) for removal of internal fixation devices (e.g., pin, rod). These codes are not separately reportable if the removal is performed as a necessary integral component of another procedure. For example, if revision of an open fracture repair for nonunion or malunion of bone requires removal of a previously inserted pin, CPT code 20670 or 20680 is not separately reportable.

Similarly, if a superficial or deep implant (e.g., buried wire, pin, rod) requires surgical removal (CPT codes 20670 and 20680), it is not separately reportable if it is performed as an integral part of another procedure.

I’m really looking for a cited/vetted resource rather than interpretation or a clinical practice. Thanks!