CPT® Code 20702

Add-On Code

Manual preparation and insertion of drug-delivery device(s), intramedullary (List separately in addition to code for primary procedure)

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.