CPT® Code 20703

Add-On Code

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.