“I performed a removal of a failed 1st metatarsophalangeal implant and, at the same setting, an arthrodesis. Should I bill for both the removal of the implant and subsequent fusion?”
It appears that the patient in question had a hallux rigidus condition affecting the first metatarsophalangeal joint of the foot that was corrected and billed using CPT code 28291 which is defined as: Hallux rigidus correction with cheilectomy, debridement and capsular release of the first MPJ; with implant. Unfortunately, the implant within the first metatarsophalangeal jointed failed, had to be removed and on the same date of service, same surgical setting, an arthrodesis was performed of the first metatarsophalangeal joint. The big question: can both of the procedures performed on the same date of service, the removal of the implant and the joint fusion be billed for?
The removal of the implant from the first metatarsophalangeal joint is probably best coded with CPT code 20680 which is defined as: Removal of implant; deep (e.g., buried wire, pin, screw, metal band, nail, rod or plate). The arthrodesis of the first metatarsophalangeal joint is best coded with CPT code 28750 which is defined as: Arthrodesis, great toe; metatarsophalangeal joint.
When the NCI Edits are accessed, CPT codes 28750 and 20680 are not bundled in any fashion. Theoretically, both of these CPT codes can be billed when the two procedures in question are performed on the same date of service, at the same surgical setting, at the same anatomical site. There is more to the story.
If the two CPT codes in question were not performed as integral parts of the same procedure, then they both could be billed. Clearly, CPT codes 20680 and 28750 ARE integral parts of the same procedure. The first metatarsophalangeal joint arthrodesis could not be performed unless the implant was first removed from the first metatarsophalangeal joint. Therefore, the only procedure that should be billed is the first metatarsophalangeal joint arthrodesis, CPT code 28750.
This is my opinion.
Michael G. Warshaw
DPM, CPC
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