CPT Code for Left Tibia Hardware Removal
The CPT code for removal of internal fixation hardware from the left tibia is 20680 (Removal of implant; deep [eg, buried wire, pin, screw, metal band, nail, rod or plate]) 1, 2.
Key Coding Information
CPT 20680 is the standard code used for removal of deep orthopedic hardware including plates, screws, rods, and nails from any extremity location, including the tibia 1. This code applies regardless of:
- Laterality: The code itself does not specify left vs. right - laterality is documented separately in the medical record
- Hardware type: Whether removing intramedullary nails, plates with screws, or other deep fixation devices
- Complexity: The same code applies whether removal is straightforward or requires advanced techniques
Important Clinical Considerations
Timing Matters for Surgical Planning
Hardware removal becomes significantly more difficult after longer implantation periods, with complications increasing substantially:
- Removal >18 months post-insertion: 1.2x higher odds of overall complications and 3x higher odds of incomplete removal/screw breakage compared to removal at 9-18 months 2
- Mean implantation time for complicated removals: 3.7 years vs. 1.1 years for uncomplicated cases (p=0.036) 1
- Operative time: Complicated removals average 95 minutes vs. 42 minutes for routine cases 1
Common Technical Challenges
When planning tibial hardware removal, anticipate these potential difficulties:
- Screw strippage: 1.1% of titanium screws 1
- Cold-welding: 0.6% of screws 1
- Broken screws: 1.0% requiring extraction techniques 1
- Bone overgrowth: 8.2% of plates require burr/trephine for removal 1
- Need for advanced tools: 7.6% of cases require screw extraction sets, trephines, or burrs beyond standard screwdrivers 1
Overall Complication Rate
The overall complication rate for hardware removal in orthopedic surgery is 9.5% 2, which is not insignificant despite this being considered a "routine" procedure. Specific complications include:
- Sustained new-onset postoperative pain: 2.6% 2
- Incomplete hardware removal: 1.6% 2
- Perioperative fracture: 1.4% 2
Lower Extremity Considerations
Lower extremity hardware removals (including tibia) are more likely to be complicated compared to upper extremity procedures (p=0.034) 1, requiring longer operative times and more frequent use of specialized extraction equipment.
Practical Surgical Planning
For left tibial hardware removal specifically:
- Obtain prior operative records when possible to identify exact hardware specifications 3
- Review imaging for evidence of bone overgrowth around implants 3
- Have screw extraction sets available in the operating room, particularly for hardware in place >18 months 1, 2
- Counsel patients that 88% experience pain relief when removal is performed for pain indication 2
- Plan adequate operative time: Budget 42-95 minutes depending on complexity 1