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The CPT® Code 20702 refers to the manual preparation and insertion of drug-delivery device(s) specifically designed for intramedullary use. This procedure is performed in conjunction with a primary surgical procedure, such as the removal of a prosthetic implant, replantation of a limb, or incision of the bone cortex. The process begins with the meticulous debridement of the surgical area, ensuring that any infected bone is thoroughly cleaned to minimize the risk of complications. Following this, a space is prepared within the intramedullary canal, which is the central cavity of the bone where the device will be placed. The surgeon fabricates the drug-delivery device using silicone tubing that matches the diameter of the patient's intramedullary canal, cutting it to the necessary length for optimal fit. This tubing is then lubricated with sterile mineral oil to facilitate smooth insertion. To create the drug-delivery mechanism, the surgeon combines cement powder with antibiotic powder, followed by the addition of a liquid monomer, mixing these components under vacuum conditions to ensure a homogeneous mixture. This liquid cement is then transferred into a pressurized insertion gun, which allows for precise delivery into the silicone tubing. The process involves clamping one end of the tube and injecting the liquid cement under pressure until the tube is completely filled. While the cement remains pliable, a small diameter rod or wire is inserted into the tube, and once the clamp is removed, the rod or wire is advanced until it protrudes from the opposite end. After the cement hardens, the silicone tube is cut and removed, leaving behind a newly formed antibiotic intramedullary nail. The surgeon then uses fluoroscopic imaging to guide the insertion of the device into the medullary canal, confirming its correct placement. The proximal end of the rod or wire is trimmed to an appropriate length to facilitate future removal if necessary. Finally, X-rays are performed to verify the accurate positioning of the device within the bone structure.
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The procedure associated with CPT® Code 20702 is indicated for the following conditions:
The procedure for CPT® Code 20702 involves several critical steps to ensure the successful preparation and insertion of the drug-delivery device:
After the procedure, careful monitoring of the surgical site is essential to ensure proper healing and to identify any potential complications. The surgical wound is closed in layers to promote optimal recovery. Follow-up imaging may be required to confirm the continued proper placement of the intramedullary drug delivery device. If removal of the device is indicated, it will be performed through an incision at the implant site, ensuring that any remaining fragments of the implant are also removed to prevent complications.
| Short Descr | MNL PREP&INSJ IMED RX DEV | Medium Descr | MANUAL PREP&INSJ INTRAMEDULLARY DRUG DLVR DEVICE | Long Descr | Manual preparation and insertion of drug-delivery device(s), intramedullary (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Packaged into APC Rates | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 20680 | MPFS Status: Active Code APC Q2 ASC A2 CPT Assistant Article Illustration for Code Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate) | 20690 | MPFS Status: Active Code APC J1 ASC J8 CPT Assistant Article Illustration for Code Application of a uniplane (pins or wires in 1 plane), unilateral, external fixation system | 20692 | MPFS Status: Active Code APC J1 ASC J8 CPT Assistant Article Illustration for Code Application of a multiplane (pins or wires in more than 1 plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type) | 20694 | MPFS Status: Active Code APC Q2 ASC A2 CPT Assistant Article Illustration for Code Removal, under anesthesia, of external fixation system | 20802 | MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Replantation, arm (includes surgical neck of humerus through elbow joint), complete amputation | 20805 | MPFS Status: Active Code APC C Illustration for Code Replantation, forearm (includes radius and ulna to radial carpal joint), complete amputation | 20838 | MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Replantation, foot, complete amputation | 21510 | MPFS Status: Active Code APC C Incision, deep, with opening of bone cortex (eg, for osteomyelitis or bone abscess), thorax | 23035 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Illustration for Code Incision, bone cortex (eg, osteomyelitis or bone abscess), shoulder area | 23170 | MPFS Status: Active Code APC J1 ASC J8 Sequestrectomy (eg, for osteomyelitis or bone abscess), clavicle | 23180 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Illustration for Code Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), clavicle | 23184 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Illustration for Code Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), proximal humerus | 23515 | MPFS Status: Active Code APC J1 ASC J8 CPT Assistant Article Illustration for Code Open treatment of clavicular fracture, includes internal fixation, when performed | 23615 | MPFS Status: Active Code APC J1 ASC J8 CPT Assistant Article Illustration for Code Open treatment of proximal humeral (surgical or anatomical neck) fracture, includes internal fixation, when performed, includes repair of tuberosity(s), when performed; | 23935 | MPFS Status: Active Code APC J1 ASC A2 Illustration for Code Incision, deep, with opening of bone cortex (eg, for osteomyelitis or bone abscess), humerus or elbow | 24134 | MPFS Status: Active Code APC J1 ASC A2 Illustration for Code Sequestrectomy (eg, for osteomyelitis or bone abscess), shaft or distal humerus | 24138 | MPFS Status: Active Code APC J1 ASC A2 Illustration for Code Sequestrectomy (eg, for osteomyelitis or bone abscess), olecranon process | 24140 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Illustration for Code Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), humerus | 24147 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Illustration for Code Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), olecranon process | 24430 | MPFS Status: Active Code APC J1 ASC J8 Illustration for Code Repair of nonunion or malunion, humerus; without graft (eg, compression technique) | 24516 | MPFS Status: Active Code APC J1 ASC J8 Physician Quality Reporting CPT Assistant Article Illustration for Code Treatment of humeral shaft fracture, with insertion of intramedullary implant, with or without cerclage and/or locking screws | 25035 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Illustration for Code Incision, deep, bone cortex, forearm and/or wrist (eg, osteomyelitis or bone abscess) | 25145 | MPFS Status: Active Code APC J1 ASC A2 Sequestrectomy (eg, for osteomyelitis or bone abscess), forearm and/or wrist | 25150 | MPFS Status: Active Code APC J1 ASC A2 Illustration for Code Partial excision (craterization, saucerization, or diaphysectomy) of bone (eg, for osteomyelitis); ulna | 25151 | MPFS Status: Active Code APC J1 ASC A2 Illustration for Code Partial excision (craterization, saucerization, or diaphysectomy) of bone (eg, for osteomyelitis); radius | 25400 | MPFS Status: Active Code APC J1 ASC J8 Illustration for Code Repair of nonunion or malunion, radius OR ulna; without graft (eg, compression technique) | 25515 | MPFS Status: Active Code APC J1 ASC J8 Illustration for Code Open treatment of radial shaft fracture, includes internal fixation, when performed | 25525 | MPFS Status: Active Code APC J1 ASC J8 Illustration for Code Open treatment of radial shaft fracture, includes internal fixation, when performed, and closed treatment of distal radioulnar joint dislocation (Galeazzi fracture/ dislocation), includes percutaneous skeletal fixation, when performed | 25526 | MPFS Status: Active Code APC J1 ASC J8 Illustration for Code Open treatment of radial shaft fracture, includes internal fixation, when performed, and open treatment of distal radioulnar joint dislocation (Galeazzi fracture/ dislocation), includes internal fixation, when performed, includes repair of triangular fibrocartilage complex | 25545 | MPFS Status: Active Code APC J1 ASC J8 CPT Assistant Article Open treatment of ulnar shaft fracture, includes internal fixation, when performed | 25574 | MPFS Status: Active Code APC J1 ASC J8 CPT Assistant Article Illustration for Code Open treatment of radial AND ulnar shaft fractures, with internal fixation, when performed; of radius OR ulna | 25575 | MPFS Status: Active Code APC J1 ASC J8 Illustration for Code Open treatment of radial AND ulnar shaft fractures, with internal fixation, when performed; of radius AND ulna | 27245 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with intramedullary implant, with or without interlocking screws and/or cerclage | 27259 | MPFS Status: Active Code APC C Open treatment of spontaneous hip dislocation (developmental, including congenital or pathological), replacement of femoral head in acetabulum (including tenotomy, etc); with femoral shaft shortening | 27360 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Illustration for Code Partial excision (craterization, saucerization, or diaphysectomy) bone, femur, proximal tibia and/or fibula (eg, osteomyelitis or bone abscess) | 27470 | MPFS Status: Active Code APC C Illustration for Code Repair, nonunion or malunion, femur, distal to head and neck; without graft (eg, compression technique) | 27506 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Open treatment of femoral shaft fracture, with or without external fixation, with insertion of intramedullary implant, with or without cerclage and/or locking screws | 27640 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Illustration for Code Partial excision (craterization, saucerization, or diaphysectomy), bone (eg, osteomyelitis); tibia | 27720 | MPFS Status: Active Code APC J1 ASC J8 Illustration for Code Repair of nonunion or malunion, tibia; without graft, (eg, compression technique) |
| RT | Right side (used to identify procedures performed on the right side of the body) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | LT | Left side (used to identify procedures performed on the left side of the body) | GC | This service has been performed in part by a resident under the direction of a teaching physician | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AF | Specialty physician | CR | Catastrophe/disaster related | GW | Service not related to the hospice patient's terminal condition | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2020-01-01 | Added | Code added. |
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