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The CPT® Code 20703 refers to the removal of drug-delivery device(s) that are placed intramedullary. This procedure is specifically categorized as a separate code that is reported in addition to the primary procedure codes, which may include the removal of a prosthetic implant, replantation of a limb, or incision of the bone cortex. The process of preparing for the implantation of an intramedullary drug delivery device involves several critical steps to ensure the device is effectively placed and functions as intended. Initially, the surgical area is meticulously debrided to eliminate any infected bone tissue, ensuring a clean environment for the device placement. Following this, a space is prepared within the intramedullary canal, which is the central cavity of the bone where the device will be inserted. The surgeon fabricates the drug delivery device using silicone tubing that is specifically sized to match the diameter of the patient's intramedullary canal. This tubing is cut to the necessary length and lubricated with sterile mineral oil to facilitate smooth insertion. The creation of the device involves mixing cement powder with antibiotic powder and a liquid monomer, which is done under vacuum conditions to ensure a homogeneous mixture. This mixture is then transferred into a pressurized insertion gun for application. During the insertion process, one end of the silicone tube is clamped, and the liquid cement is injected under pressure to fill the tube completely. A small diameter rod or wire is then passed through the tube while the cement is still in a pliable state, allowing for the formation of a solid intramedullary nail once the cement hardens. The device is inserted into the medullary canal under fluoroscopic guidance, ensuring accurate placement, and the position is confirmed through X-ray imaging. When it comes time to remove the intramedullary drug delivery device, the procedure involves making an incision at the implant site to expose the device. The surgeon carefully removes the device while ensuring that any fragments or shards of the implant that may have broken off are also extracted. The surgical site is then closed in layers to promote proper healing. This comprehensive approach to both the implantation and removal of the intramedullary drug delivery device underscores the complexity and precision required in these procedures.
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The removal of drug-delivery device(s) using CPT® Code 20703 is indicated in specific clinical scenarios where the device is no longer needed or has become problematic. The following conditions may warrant this procedure:
The procedure for the removal of the intramedullary drug delivery device involves several critical steps to ensure safe and effective extraction. The first step is to make an incision at the site of the implant, which allows the surgeon to access the device directly. Once the incision is made, the surgeon carefully dissects through the surrounding tissue to expose the drug-delivery device. It is essential to handle the surrounding tissues delicately to minimize trauma and promote healing.
After the removal of the intramedullary drug delivery device, post-procedure care is essential for optimal recovery. Patients are typically monitored for any signs of complications, such as infection or excessive bleeding. Pain management may be provided as needed, and patients are advised on activity restrictions to allow for proper healing. Follow-up appointments are often scheduled to assess the surgical site and ensure that the recovery process is proceeding as expected. Additionally, any necessary imaging studies, such as X-rays, may be performed to confirm that all fragments of the device have been successfully removed and that the area is healing appropriately.
| Short Descr | RMVL IMED RX DELIVERY DEVICE | Medium Descr | REMOVAL INTRAMEDULLARY DRUG DELIVERY DEVICE | Long Descr | Removal 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.
| 23485 | MPFS Status: Active Code APC J1 ASC J8 Illustration for Code Osteotomy, clavicle, with or without internal fixation; with bone graft for nonunion or malunion (includes obtaining graft and/or necessary fixation) | 24430 | MPFS Status: Active Code APC J1 ASC J8 Illustration for Code Repair of nonunion or malunion, humerus; without graft (eg, compression technique) | 24435 | MPFS Status: Active Code APC J1 ASC J8 Illustration for Code Repair of nonunion or malunion, humerus; with iliac or other autograft (includes obtaining graft) | 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) | 25405 | MPFS Status: Active Code APC J1 ASC J8 Illustration for Code Repair of nonunion or malunion, radius OR ulna; with autograft (includes obtaining graft) | 25415 | MPFS Status: Active Code APC J1 ASC J8 Illustration for Code Repair of nonunion or malunion, radius AND ulna; without graft (eg, compression technique) | 25420 | MPFS Status: Active Code APC J1 ASC J8 CPT Assistant Article Illustration for Code Repair of nonunion or malunion, radius AND ulna; with autograft (includes obtaining graft) | 25425 | MPFS Status: Active Code APC J1 ASC J8 Illustration for Code Repair of defect with autograft; radius OR ulna | 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 | 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) | 27472 | MPFS Status: Active Code APC C Illustration for Code Repair, nonunion or malunion, femur, distal to head and neck; with iliac or other autogenous bone graft (includes obtaining graft) | 27720 | MPFS Status: Active Code APC J1 ASC J8 Illustration for Code Repair of nonunion or malunion, tibia; without graft, (eg, compression technique) | 27722 | MPFS Status: Active Code APC J1 Illustration for Code Repair of nonunion or malunion, tibia; with sliding graft | 27724 | MPFS Status: Active Code APC C Illustration for Code Repair of nonunion or malunion, tibia; with iliac or other autograft (includes obtaining graft) | 27725 | MPFS Status: Active Code APC C Illustration for Code Repair of nonunion or malunion, tibia; by synostosis, with fibula, any method |
| 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). | 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.) | 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). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | 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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