From: Michael G. Warshaw, DPM, CPC
In order to appropriately address the posted scenario, it is important to access the 2024 CPT Manual. Under Surgery Guidelines, you need to access the “Foreign Body/Implant Definition.” Foreign Body/Implant Definition:
• “An object intentionally placed by a physician or other qualified health care professional for any purpose (e.g. diagnostic or therapeutic) is considered an implant. An object that is unintentionally placed (e.g. 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.”
If Implant Needs to be Removed (i.e. Internal Fixation):
• 20680 Removal of implant; deep (e.g., buried wire, pin, screw, metal band, nail, rod or plate)
If Foreign Body is Removed:
• 28190 Removal of foreign body, foot; subcutaneous
• 28192 Removal of foreign body, foot; deep
• 28193 Removal of foreign body, foot; complicated
Based upon the location and position of the broken K-wire described within the post, the most appropriate CPT code to bill is CPT code 28190 appended by the T2 or the T7 Modifier depending upon whether it was the left 3rd toe, or the right 3rd toe that was involved.
Michael G. Warshaw, DPM, CPC, Mount Dora, FL
From: Steven Berkey, DPM
According to my understanding of the guidelines, a K-wire that's broken and not performing the function for which it was intended now becomes a foreign body. The appropriate way to bill would be removal of a foreign body (deep) with a -78 modifier.
Steven Berkey, DPM, Plano, TX
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