CPT codes are a standardized language used by healthcare providers for billing and documentation of medical, surgical, and diagnostic procedures. CPT Code 20680 specifically describes the surgical removal of an internal, deeply embedded orthopedic implant. This procedure involves extracting fixation devices previously placed to stabilize a fracture or support a bone structure.
Defining Deep Implant Removal
The procedure identified by CPT 20680 involves extracting hardware that lies beneath the superficial layer of muscle or fascia. This depth requires the surgeon to make a significant incision and perform careful dissection to reach and visualize the implant site. The hardware covered includes internal fixation devices such as metal plates, pins, screws, bands, intramedullary nails, and rods. These devices were initially placed to assist in the healing of a bone or joint.
The defining characteristic is the necessity of an extensive surgical approach to access the device. Due to its complexity, the procedure is typically performed in a hospital operating room or an ambulatory surgical center. Once the hardware is removed using specialized instruments, the wound requires a meticulous, layered closure, differentiating it from simpler procedures performed on surface-level implants.
The code applies to the removal of all hardware from a single anatomical site. This includes complex systems, such as an intramedullary rod with locking screws, even if multiple incisions are needed for extraction. For instance, removing a plate and all associated screws from a femur fracture is billed as a single unit of CPT 20680, representing the complete removal of the entire fixation system from one area.
How Depth Affects Coding
The surgical depth is the primary factor that determines the correct billing code and reflects the procedure’s complexity. CPT 20680 is used exclusively for deep implant removal, which necessitates operating beyond the initial tissue layers. This deep access requires greater surgical skill, more operating time, and often general or regional anesthesia to ensure patient comfort and safety.
This code is distinct from its counterpart, CPT 20670, which is reserved for the removal of superficial implants. Superficial devices, such as temporary K-wires or external pins that do not pass beneath the fascia, can often be removed with a minor incision or simply by pulling, sometimes in a physician’s office. This removal requires a less extensive closure and a lower level of anesthesia.
The difference in surgical effort and required resources justifies the separate and higher valuation of CPT 20680 compared to CPT 20670. This distinction ensures that the complexity associated with deep tissue dissection, scar tissue, and proximity to nerves and vessels is accurately captured. Procedures coded with 20680 typically involve dissection down to the bone, followed by a multi-layered repair of the soft tissues.
Clinical Scenarios Requiring Removal
The need for a CPT 20680 procedure arises from several medical factors, generally occurring months or years after the initial hardware placement. A frequent reason for removal is pain or discomfort caused by the hardware, particularly when the implant is prominent beneath the skin in areas like the ankle or wrist. Mechanical irritation of soft tissues can become symptomatic even after the bone has fully healed.
Infection is another serious indication requiring immediate removal, as bacteria can form a biofilm on the implant surface, which antibiotics struggle to penetrate. Implant failure, such as hardware loosening, migration, or breakage, also necessitates a surgical procedure to extract the compromised device. In these situations, the hardware is no longer serving its intended purpose and may be actively causing harm.
Elective removal, where the patient requests the procedure after complete bone union, is also a common scenario. This is often driven by a desire to return to high-impact sports, psychological comfort, or a rare metal hypersensitivity reaction to the implant materials. For pediatric patients, removal is sometimes recommended to prevent the hardware from interfering with natural bone growth.
Understanding Insurance and Patient Costs
Billing for CPT 20680 includes the surgeon’s professional fee, the anesthesia provider’s fee, and a facility fee for the operating room and recovery services. Insurance coverage for this deep implant removal depends heavily on demonstrating “medical necessity.” If the removal is required due to pain, infection, or implant failure, it is generally considered medically necessary and is more likely to be covered.
If the removal is purely elective, such as a patient requesting the procedure after complete healing without symptoms, insurance providers may consider it cosmetic or non-medically necessary, leading to higher out-of-pocket costs. Patients should consult their insurance plan to understand deductibles, co-pays, and co-insurance for surgical procedures performed in an ambulatory or hospital setting.
The reimbursement for the surgeon’s time is determined by a fee schedule, and the patient’s final financial responsibility is influenced by their specific plan’s contract rates. If the implant removal is performed as an integral part of a larger, revisionary surgery, the CPT 20680 code may be bundled into the primary procedure code and not billed separately. Pre-authorization is a prudent step for patients to confirm their financial liability before the procedure.