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Use of amniotic membrane when coding removal of hardware

I am running into an issue with this case. The use of amniotic membrane is new to us and are having a hard time getting both a working HCPC and procedure code for the use of the membrane. I have spent several hours looking for something and can not seem to come up with anything. Any help would be greatly appreciated.

PROCEDURE:
1. Removal of hardware.
2. Use of amniotic membrane tissue allograft.

INDICATIONS FOR PROCEDURE: This is a 71-year-old female who had hardware placed in
her toe some 15 years ago. She has loosening of the hardware and the distal screw is backing out
causing hypertrophic callus on the dorsum of her IP joint of her left great toe. She wishes to have
the hardware removed. The risks and benefits of surgery have been explained and informed
consent obtained.
OPERATIVE NOTE: The patient was taken to the operating room and placed in the supine
position. Once adequate anesthesia was obtained, the left upper extremity was prepped and draped
in the usual sterile fashion. Esmarch was used to exsanguinate the limb and was tied proximally
as a tourniquet. A midline skin incision was created. Soft tissue dissection was carried down to
the hardware which is easily removed. The wound is copiously irrigated. The skin edges are
approximated with 3-0 nylon in a running fashion. Amniotic membrane tissue Matrix allograft
was injected. The wound was dressed with Adaptic, 4 x 4’s, Kling, and Ace wrap. Esmarch is
removed. The patient taken to recovery in stable condition. No complications. The patient
tolerated the procedure well.

Medical Billing and Coding Forum

Is excision of exostosis included with hardware removal?

Hi,

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!

Medical Billing and Coding Forum

Can you bill a repair when you are removing hardware?

I have a patient, that doctor removed painful hardware in the ankle.
two separate incisions so I coded 20680 rt, 20680, 59 ,rt
The note states – prominent hardward was wearing through the deltoid, so when he removed the screw and washer – he repaired the deltoid.
Can I also bill 27698??
thanks in advance for your advice

Medical Billing and Coding Forum

Exchange of hardware?

Coding gurus, I’m at a loss on this one. We had a patient that had ORIF of a proximal humerus fracture and then, a month later had a second procedure.
Indications: Prominent hardware and suture abscess.
Operation Performed: Left shoulder superficial I and D with exchange of proximal locking screws.

Should I code unlisted for the hardware exchange, or could I code repeat ORIF with reduced services?

Description of procedure:
“…….no fluid collection or purulence was found in the subcutaneous or deep tissues. The areas around the suture abscess was cultured anyway. This area was copiously irrigated and the soft tissues were dissected to ensure there were no pickets of infection or purulence. After utilizing the deltopectoral interval, the proximal portion of the previously placed plate was exposed. The fracture site was palpated and found to be firm and stable. The C-arm was sterilely draped and brought onto the field and screws, which appeared to be threatening the penetration of the subchondral bone were identified and removed. These were then exchanged for shorter screws with the aid of fluoroscopy to ensure appropriate length”

Thanks,
Tobi C.

Medical Billing and Coding Forum

Osteotomy, Subtrochanteric with internal fixation, hardware removal, and bone graft

We are billing 27165 – in encoder pro it states graft 20900/20902 is billable if from a distant site. I have always understood that to mean opposite limb or separate incision but when I put the two codes into encoder pro they are not bundled??

Medical Billing and Coding | AAPC Forum