CPT code 20680 identifies a specific surgical action within the musculoskeletal system used by medical professionals to document and bill for procedures. This structured system ensures uniform communication about healthcare interventions across the United States. The code is necessary for proper documentation and accurate reimbursement for the service provided.
Defining the Surgical Procedure
CPT code 20680 is designated for the surgical removal of a deep implant, including fixation hardware such as buried wires, pins, screws, nails, rods, or plates. These devices are typically made of materials like stainless steel or titanium alloys. They are placed during initial surgery to stabilize severe fractures or fusion sites within the musculoskeletal system. The code’s application is defined by the anatomical depth and complexity required to access the device.
The procedure involves the surgeon making an incision directly over the implant site, followed by meticulous dissection through layers of tissue. This careful separation often requires navigating deep into muscle and down to the bone level where the fixation material is embedded. The complexity is distinct because the implant is fully buried and requires visualization for removal.
Specialized instruments like surgical screwdrivers, wrenches, and retrieval systems are used to safely extract the hardware from the bone. CPT code 20680 covers the removal of all components (screws, plates, rods) from a single fracture site or area of injury. This applies even if multiple incisions are needed to complete the extraction of a single system, such as an intramedullary rod. Once the hardware is removed, the surgeon performs a complex, layered closure of the incision to ensure proper healing of the deep tissues.
Clinical Justification and Timing
The decision to perform a deep implant removal is driven by clinical circumstances where the continued presence of the hardware is detrimental to the patient’s health or comfort. Common reasons include persistent pain, irritation, or discomfort caused by the hardware itself, such as a screw head rubbing against a tendon. Hardware failure, including the breakage or migration of a plate or rod, also necessitates removal to prevent further injury or address instability.
Infection surrounding the implant site is another urgent indication, as bacteria can form a protective biofilm on the metal surface that resists antibiotic treatment. Patients may also require removal if the fixation material is not compatible with Magnetic Resonance Imaging (MRI), making follow-up diagnostic imaging difficult or unsafe. The procedure is sometimes planned as part of a multi-stage treatment, particularly in pediatric cases where the hardware could interfere with bone growth.
The timing of this surgery is a significant clinical consideration, typically occurring only after the original injury has completely healed, which usually takes months to years. Radiographic evidence must confirm that the bone has achieved full union before hardware removal is considered stable. Removing the fixation before adequate healing risks re-fracture or loss of alignment.
Differentiating Similar Procedures
The distinguishing factor for CPT 20680 is the depth and complexity of the surgical access required, separating it from the less invasive CPT code 20670. Code 20670 is used for the removal of superficial fixation material, such as wires or pins easily accessible just beneath the skin or in subcutaneous tissue. These superficial removals are simple procedures that may not require a formal incision or layered closure, often involving just a small stab incision to retrieve the device.
Procedures billed under 20670 are quick and simple enough to be performed in a physician’s office or an outpatient clinic setting under local anesthesia. Conversely, the deep dissection necessary for a 20680 procedure requires the controlled environment of a hospital operating room or an ambulatory surgical center (ASC). The surgeon must navigate through muscle and bone, often requiring general or regional anesthesia for patient safety.
The distinction between the codes is based on the implant’s anatomical location and the difficulty of removal, not its size. For example, a small screw embedded deep within the femur bone requires a deep dissection and layered closure, warranting the 20680 code. A larger pin that remains partially exposed or just under the skin following a minor hand fracture would be considered superficial removal, falling under 20670. This difference in surgical complexity is directly reflected in the coding guidelines.
Understanding Coverage and Costs
Since the removal of deep implants is almost always performed for medical necessity—to resolve pain, address complications, or complete a treatment plan—CPT code 20680 is covered by both private insurance plans and government programs like Medicare. Coverage is contingent upon documented medical necessity, which must be supported by clinical notes and imaging studies showing the reason for the removal. Without this documentation, the claim may be denied.
The total cost to the patient is influenced by the setting where the surgery takes place. Procedures performed in a hospital operating room often incur higher facility fees than those done in a standalone ambulatory surgical center. The overall bill includes fees for the surgeon, the anesthesiologist, facility usage, and specialized equipment or supplies. The listed fee for a CPT 20680 procedure can vary widely, ranging from a few thousand dollars in an ASC to tens of thousands of dollars in a hospital setting.
In the billing process, modifiers may be appended to CPT 20680 to communicate specific details to the payer. For example, Modifier 22 is used if the surgery was significantly more difficult than usual due to excessive scarring or hardware breakage, justifying a higher reimbursement. Modifier 59 is added when a surgeon removes hardware from two distinct, noncontiguous anatomical sites during the same operative session.