“I have an adult patient who suffered from posterior tibial tendon dysfunction. A local surgeon addressed this by placing a subtalar joint arthroereisis implant. This had a very positive effect on the structure of the foot and reducing the symptoms at the posterior tibial tendon. Unfortunately, 5 months after the procedure, she is now having symptoms at the subtalar joint and would like the implant removed. There has been no movement of the implant and no breakage of the implant. With the 2022 CPT changes, does the removal of this implant count as an “implant” or “foreign body?”
So, an implant was placed within the subtalar joint to address a patient’s problem with posterior tibial dysfunction. The implant was functioning well for a period of approximately five months, when at that point in time, the patient started to have symptoms at the subtalar joint (STJ) and wanted the implant removed from the foot. It is important to note that the implant never moved, and it did not break. Based upon the 2022 CPT changes of implant versus foreign body, which CPT code would be the appropriate one to bill?
As I have stated previously, it is important to access the 2022 CPT Manual. Under Surgery Guidelines, you are able to access “Foreign Body/Implant Definition:
“An object intentionally placed by a physician of other qualified health care professional for any purpose (eg. diagnostic or therapeutic) is considered an implant. An object that is unintentionally placed (eg. trauma or ingestion) is considered a foreign body. If an implant (or part thereof) has moved from its original position or is structurally broken and no longer serves its intended purpose or presents a hazard to the patient, it qualifies as a foreign body for coding purposes, unless CPT coding instructions direct otherwise or a specific CPT code exists to describe the removal of that broken/moved implant.”
In the above post, based upon the fact that the STJ implant did not retract out from within the STJ and the implant was not broken or damaged in any way, plus the only symptom that was reported by the patient were “symptoms at the subtalar joint,” the most appropriate CPT code to bill is: CPT 20680 which is defined as: Removal of implant; deep (e.g., buried wire, pin, screw, metal band, nail, rod or plate). This would not be classified as a foreign body.
This is my opinion.
Michael G. Warshaw
DPM, CPC
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