“I have a newer associate who was taught at his previous practice, that extracting exposed K-wires after hammertoe surgery around the typical 4-week interval is a billable charge. His previous employer had him billing CPT code 20680 for this, but a biller from a different office advised him to bill CPT code 20670 instead.
He is billing the following coding scenario within the 90-day post operative global period for hammertoe correction (28285) x3: 20670 Rt, 58 M20.41, Z97.8, Z47.89 (to be listed on 3 separate lines on the claim form with the additional toe T-modifiers).
He thought it was fine since it's marked as a staged procedure. I told him I've read several coding articles over the years that say you cannot bill for this in this scenario.”
“My questions are:
1) Did something change and we can bill for extracting percutaneous K-wires now?
2) Is there something I can show him noting that 20670/20680 are not appropriate CPT codes to bill for this procedure and is part of the global care of the 28285 surgery since the wires were expected to be removed when the surgery was performed? Thank you.”
Whenever I lecture at a conference, specifically regarding coding and billing, I always start off with the following quotes directed at the physicians:
“PERCEPTION IS REALITY”
“IF YOU SEARCH HARD ENOUGH, YOU WILL ALWAYS FIND SOMEONE TO TELL YOU WHAT YOU WANT TO HEAR”
“RULES AND REGULATIONS ARE NOT OPEN TO INTERPRETATION “
With respect to the scenario that needs to be addressed, all three of the quotes apply, especially #2.
When a hammertoe is corrected and CPT code 28285 is billed (Correction, hammertoe (e.g. interphalangeal fusion, partial or total phalangectomy)) and the surgical site is fixated with a percutaneous K-wire that protrudes out through the distal aspect of the toe, the intent all along is to remove the K-wire at point “X” in the future when the surgical site is healed. This is part of the procedure. Clearly, the patient is not going to continue through life with a K-wire sticking out of the tip of the toe. The 58 modifier does not apply here. This is not pre-planned. This is not staged. This is not more extensive than the original procedure. It is classified as part of the original procedure. The removal of the percutaneous K-wire is part of the hammertoe correction, and it is included in the reimbursement for the procedure.
The two CPT codes that were suggested to be billed for the removal of the K-wire are CPT codes 20680 and 20670. They are defined as the following:
20670 Removal of implant; superficial (e.g., buried wire, pin or rod) (separate procedure)
20680 Removal of implant; deep (e.g., buried wire, pin, screw, metal band, nail, rod or plate)
The operative word in both CPT definitions is BURIED. Clearly, a percutaneous K-wire protruding out of the distal aspect of a toe is not BURIED. This supports the fact that it is inappropriate to bill for the extracting of a percutaneous K-wire following hammertoe surgery, or for that matter any foot surgery.
This is my opinion.
Michael G. Warshaw, DPM, CPC
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