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CPT Code 20692 and Related Codes 20693, 20694, 20695

CPT Code 20692: Application of a Multiplane External Fixation System

CPT 20692 is used for the application of a multiplane (pins or wires in more than one plane), unilateral, external fixation system, such as the Ilizarov or Monticelli types. This procedure involves attaching metal pins or wires to the bone, which are then connected externally by rings or bars to stabilize complex fractures, correct deformities, or facilitate limb lengthening. 

It is performed when traditional casting or internal fixation is insufficient. This procedure requires precision for proper bone alignment and is typically high in complexity, often involving prolonged operative time and careful postoperative management. Modifiers may be used for bilateral procedures, increased services, or staged procedures as appropriate.

CPT Code 20693: Adjustment or Revision of External Fixation System

CPT 20693 describes the surgical adjustment or revision of an existing external fixation system under anesthesia. This involves making modifications such as inserting new pins, wires, rings, or bars to improve or correct the alignment of the bone during the healing process. 

The procedure usually happens after the initial fixation when healing is ongoing, but adjustments are necessary for optimal bone stability. It is considered moderate complexity and requires anesthesia due to the invasive nature of the intervention.

CPT Code 20694: Removal, Under Anesthesia, of External Fixation System

CPT 20694 is used to bill for the removal of an external fixation device under anesthesia after the fracture or bone deformity has healed sufficiently. This surgical procedure involves detaching and removing all external pins, wires, rings, or bars that were initially placed for stabilization. 

The removal requires anesthesia to minimize patient discomfort and ensure safety. It is a moderate complexity procedure typically performed in outpatient or inpatient surgical settings as the final step in external fixation treatment.

These three CPT codes cover the full treatment continuum involving external fixation—from application (20692), through adjustments during healing (20693), to removal upon bone healing completion (20694).

CPT Code 20692 vs 20693 vs 20694 vs 20695

Here is a comparison table of the CPT codes 20692, 20693, 20694, and 20695 related to external fixation procedures:

CPT CodeDescriptionProcedure DetailsComplexityTypical Usage
20692Application of a multiplane external fixation systemApplying a ring fixator, such as Ilizarov or Monticelli, involving pins or wires in more than one plane to stabilize complex fractures or deformitiesHighInitial application of multiplane external fixation
20693Adjustment or revision of an external fixation systemModifying or updating an existing fixator, such as inserting new pins or wires under anesthesia to improve alignmentModerateDuring the healing process for correction or stabilization
20694Removal, under anesthesia, of the external fixation systemSurgically removing the fixator hardware (pins, wires, rings, bars) after healing, performed under anesthesiaModerateFinal removal after successful bone healing
20695Removal of external fixation device without anesthesia (if applicable)Less invasive removal is often done outpatient basis without anesthesiaLowWhen anesthesia is not required, typically outpatient

Key points:

  • 20692 is used for the initial application of complex, ring-based fixators like Ilizarov.
  • 20693 involves adjustments or revisions, typically under anesthesia, to optimize healing.
  • 20694 is the removal procedure after successful healing, requiring anesthesia.
  • 20695 (not included directly in your query but documented) usually covers removal without anesthesia and in outpatient settings.

This comparison helps differentiate the procedures based on complexity, purpose, and coding.

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