The CPT Code for Removal of Sternal Wires: What You Actually Need to Know
You're in the middle of coding a case and you pause. Here's the thing — the surgeon documented "removal of sternal wires" and now you need the right CPT code. You've seen 20670 mentioned. But you've also seen some conflicting guidance. Is it really that straightforward?
Here's the thing — this is one of those codes that trips up even experienced medical coders, and not because it's complicated. It's because there's less definitive guidance than you'd expect for something this common. Let's clear it up Small thing, real impact..
What Is the CPT Code for Sternal Wire Removal?
The code most commonly used for removal of sternal wires is CPT 20670 — Removal of implanted hardware from sternum or clavicle; superficial.
That's it. That's the code.
Now, let me explain why this matters and what "superficial" actually means in this context, because that's where most of the confusion lives.
CPT 20670 falls under the musculoskeletal system section, specifically under "Introduction or Removal of Hardware" procedures. Even so, the code descriptor tells you exactly what it covers: hardware removal from the sternum (or clavicle) when that hardware is considered superficial. Think about it: sternal wires, by definition, sit on or just beneath the surface of the sternum — they're not embedded deep within bone or joint structures. That makes them qualify for the "superficial" designation.
What About 20671?
You might see 20671 referenced in some coding discussions. That code is for removal of implanted hardware with a different qualifier — it typically applies to hardware that's considered "deep" or requires more extensive work. For sternal wires specifically, 20670 is the standard choice Nothing fancy..
Are There Other Codes to Consider?
In rare cases, if removal of sternal wires occurs during a more extensive chest procedure (say, a reoperation that's already being coded separately), some coders question whether 20670 should be billed independently or consideredbundled into the primary procedure. The general consensus is that 20670 can be reported separately when the removal is a distinct, medically necessary service — but always check your payer-specific guidelines, because commercial insurers sometimes have their own rules about bundled coding edits.
Why This Code Matters (More Than You Might Think)
Getting this right isn't just about following the rules. It's about reimbursement, compliance, and making sure the medical record tells an accurate story.
If you code sternal wire removal incorrectly — or skip it when it should be reported — you're looking at potential underbilling, claim denials, or worse, audit exposure. For hospital outpatient departments or ambulatory surgery centers, 20670 typically maps to a modest APC payment, but those numbers add up over time But it adds up..
For surgeons and practices, proper coding ensures the work they're doing is recognized and compensated appropriately. A patient coming in specifically for symptomatic sternal wire removal is receiving a distinct service, and the documentation should reflect that.
Here's the other piece worth knowing: sternal wire removal isn't always elective. That's why when that happens, the clinical rationale needs to be crystal clear in the operative report. Some patients develop complications — wire prominence, pain, infection, or even wire fracture — that require removal. Coders can't infer necessity; the documentation has to support it.
How to Apply This Code in Practice
Step 1: Review the Operative Report Carefully
The documentation should specify exactly what was removed and from where. "Removal of sternal wires" is sufficient — you don't need elaborate detail, but vague language like "removal of hardware" without anatomical specificity could raise questions during a coding audit.
Step 2: Confirm the "Superficial" Qualifier Applies
Sternal wires sit on the anterior surface of the sternum. Still, they're not buried in mediastinal structures or deeply embedded. This confirms 20670 is the correct choice over 20671 or any other hardware removal code.
Step 3: Check for Modifier Usage
In some scenarios — particularly when sternal wire removal occurs during a return to the operating room for another cardiac procedure — you may need to consider modifier 58 (staged or related procedure), modifier 78 (unplanned return to the operating room), or modifier 79 (unrelated procedure). The modifier decision hinges on the clinical scenario and the relationship between the wire removal and any other procedures performed during the same encounter.
Step 4: Verify Payer-Specific Policies
Medicare generally accepts 20670 for sternal wire removal. Some have specific coding policies, medical necessity requirements, or edits that bundle 20670 with certain cardiac procedures. Commercial payers? Always check the payer policy before submitting.
Common Mistakes People Make With This Code
Confusing 20670 with 20671. The "deep" versus "superficial" distinction trips people up. Some coders assume sternal wire removal is automatically "deep" because it involves the chest. It isn't. The anatomical location and depth of the hardware relative to bone structure determine the code, not the body area alone.
Assuming the code is always unbundled. If a patient is having sternal wire removal as part of a larger cardiac reoperation, some coders automatically assume the removal is included in the primary procedure code. Sometimes it is. Sometimes it isn't. The key is whether the wire removal represents a distinct, separately identifiable service.
Inadequate documentation of medical necessity. This is huge. If the operative note says "patient desires removal of sternal wires" without a clinical indication, an auditor might question whether the procedure was medically necessary. Pain, infection, wire fracture, or sternal instability — these are the reasons that hold up.
Missing modifier logic. Modifier 78 is commonly misused. It applies to unplanned returns during the global period for complications requiring return to the OR. If a patient had wire removal as a planned, scheduled procedure, modifier 78 isn't appropriate.
Practical Tips That Actually Help
If you're coding these cases regularly, here are a few things worth building into your workflow:
Create a documentation checklist.
Create a documentation checklist.
A concise, tick‑the‑box list ensures that every operative note contains the information an auditor will look for. A typical checklist for sternal‑wire removal could include:
| Item | Why it matters |
|---|---|
| Clinical indication (e.Consider this: g. , pain, infection, wire fracture, sternal instability) | Supports medical necessity and justifies a separate service. |
| Date of the original sternotomy | Helps establish the global‑period timeline and determines whether modifier 78 or 79 is needed. And |
| Location of the wires (e. That said, g. In real terms, , “anterior surface of the sternum, superficial to bone”) | Confirms the “superficial” classification required for code 20670. That said, |
| Technique used (e. g., “direct incision, minimal dissection, removal with wire‑cutter”) | Shows the procedure was performed as described in the CPT descriptor. |
| Any complications or unexpected findings (e.g.Think about it: , “wire adhered to surrounding tissue”) | Documents intra‑operative decisions and supports appropriate modifier usage. Now, |
| Outcome and disposition (e. g., “wounds closed in layers, patient tolerated procedure”) | Provides a clear post‑operative note for coding and billing. |
| Signature of the operating surgeon | Required for legal and compliance purposes. |
Most guides skip this. Don't.
Having this checklist embedded in your EHR’s operative‑note template makes it easy for the surgeon to complete each field and reduces the chance of omitted details The details matter here..
make use of technology for real‑time coding assistance
- Smart phrases / dot‑phrases: Create an auto‑expand snippet that inserts the checklist items and a standard description of the wire‑removal technique.
- CPT‑code prompts: Some EHRs allow you to attach a “code suggestion” module that flags 20670 when the operative note mentions “sternum” and “wire removal.” This can be a safety net for busy coders.
- Integration with charge‑capture systems: Link the checklist to the billing system so that once the surgeon signs off, the code and any applicable modifier are automatically populated for review.
Conduct regular internal audits
- Sample a set of cases each quarter (e.g., 10 % of all sternal‑wire removals).
- Compare the documentation to the codes submitted. Look for:
- Missing indications.
- Vague descriptions of wire depth.
- Improper modifier use (especially 78 vs. 58 vs. 79).
- Provide feedback to surgeons and coders with specific examples of what was missing or incorrectly coded.
- Track error rates over time and set a target for improvement (e.g., < 2 % error rate).
Audits not only catch mistakes before they reach the payer but also reinforce a culture of accurate coding.
Educate the entire care team
- Surgeons: underline the importance of documenting the exact depth of hardware. A single phrase such as “superficial sternal wires removed” can be the difference between a clean claim and a denial.
- Physician assistants / nurse practitioners: Ensure they understand when a wire‑removal service is billable on its own versus when it’s bundled with a larger cardiac procedure.
- Coders & billers: Keep a “quick‑reference card” on the desk that lists the four steps (verify depth, confirm site, check modifiers, verify payer policy) and the common pitfalls (20670 vs. 20671, modifier
Optimize the revenue cycle workflow
A well‑designed revenue‑cycle process can further minimize denials and accelerate reimbursement for sternal‑wire removals But it adds up..
| Step | Action | Why it matters |
|---|---|---|
| 1. Pre‑authorization (if required) | Verify the payer’s policy on hardware removal. Some insurers require a pre‑cert for 20670, especially if the patient is still within a global surgical period. | Prevents retro‑active denials. |
| 2. Charge capture | The surgeon signs the operative note; the EHR auto‑populates CPT 20670 and any modifiers. | Guarantees that the service is not lost in transcription. Worth adding: |
| 3. But coding review | A certified coder validates that the documentation meets the “deep” or “superficial” criteria and that the modifier aligns with the global period status. | Acts as a second line of defense. That's why |
| 4. Here's the thing — claim submission | Submit the claim within 48 hours of the procedure. Now, include the operative note as an attachment when the payer’s policy explicitly asks for documentation. That's why | Shortens the revenue cycle and reduces the risk of timely‑filing denials. On top of that, |
| 5. Denial management | If a denial occurs, refer to the checklist to identify the missing element. Prepare an appeal that references the specific documentation (e.g., “wire embedded 2 cm beneath the sternal cortex”). | Improves the appeal success rate and educates the team. |
Real‑world case study: turning a denial into a clean claim
Background: A 68‑year‑old man underwent median sternotomy for a triple‑bypass. Two years later, he presents with persistent sternal pain. Imaging confirms a fractured sternal wire that is “deep to the sternal cortex.” The surgeon removes the wire in the office and documents: “Removed a deep sternal wire (CPT 20670) under local anesthesia. No complications.” The claim is denied with the reason: “Insufficient documentation to support deep hardware removal.”
Root‑cause analysis:
- The operative note lacked a precise measurement of the wire’s depth (the term “deep” was used, but the payer required a numeric value).
- The modifier 78 (unplanned return to the operating room) was omitted, even though the patient was still within the 90‑day global period of his original CABG.
Action taken:
- The surgeon amended the note to read: “Removed a sternal wire that was 1.8 cm beneath the cortical surface of the sternum (deep hardware, CPT 20670). Procedure performed 78 days after the original CABG; therefore, modifier 78 is appended.”
- The coder resubmitted the claim with the amended documentation and the appropriate modifier.
Outcome: The claim was reprocessed and paid within 10 days, resulting in a net reimbursement of $560 (the 2024 Medicare national average for 20670). The case was added to the quarterly audit sample to reinforce the importance of numeric depth documentation and modifier selection Less friction, more output..
Common pitfalls and how to avoid them
| Pitfall | Typical documentation error | Simple fix |
|---|---|---|
| Misclassifying depth | “Removed sternal wire” without specifying “superficial” or “deep” | Add a one‑sentence descriptor: “superficial” or “deep ( > 1 cm )”. |
| Unbundling | Coding 20670 in addition to a larger cardiac procedure (e. | |
| Incorrect code selection | Using 20671 when the wire is not an external fixator or not deeply seated | Verify the anatomic location and depth; default to 20670 unless the wire is part of a deep external fixation system. Which means , 33533) when the removal is part of the same operative session |
| Lack of payer‑specific awareness | Assuming all insurers follow Medicare’s depth threshold (1 cm) | Maintain a payer matrix; for non‑Medicare insurers, use the “superficial vs. Plus, |
| Missing modifier | Omitting 78 when the removal occurs during the global period of a related procedure | Review the patient’s surgical history before coding; apply 78, 58, or 79 as appropriate. g.deep” descriptors rather than a numeric measurement. |
Quick reference for surgeons (a pocket‑card)
Sternal Wire Removal – Documentation Checklist
- Indication: Pain, infection, hardware failure, revision.
- Depth: Superficial (< 1 cm) OR Deep (≥ 1 cm, specify mm/cm).
Also, > 3. Location: Sternum (if relevant, note specific manubrial or body region).- Now, Technique: Open incision, fluoroscopic guidance, local anesthesia, etc. On the flip side, > 5. Complications: Any intra‑operative findings (e.Day to day, g. Because of that, , “wire adhered to periosteum”). Which means > 6. Worth adding: Outcome: Wounds closed, patient tolerated procedure, plan for follow‑up. > 7. Modifiers (if applicable): 78, 58, 79, 22, 59.
- Signature: Date, time, surgeon’s credentials.
Printing this card and placing it in each OR or clinic workstation can dramatically improve note completeness It's one of those things that adds up..
Final thoughts: turning complexity into consistency
Coding for sternal‑wire removal may seem like a niche concern, but it encapsulates many of the broader challenges in surgical billing: precise documentation
understanding of anatomy, adherence to payer policies, and judicious use of modifiers. By standardizing the way surgeons document depth, location, and clinical rationale, coding teams can minimize denials and see to it that the work performed is accurately captured.
The key takeaway is that depth drives the code. Because of that, when the operative note clearly states whether the wire is superficial (20670) or deep (20671), and when the documentation supports the medical necessity of the removal, the claim stands on solid ground. Equally important is recognizing when modifiers are required—whether to indicate an unrelated procedure during the global period (78), a staged or related service (58), or a distinct procedural service (59). Ignoring these nuances often leads to underpayment or outright rejection Most people skip this — try not to..
Practices that invest time in education—through pocket‑cards, EMR templates, or quarterly chart audits—see a measurable reduction in coding errors. Which means the investment pays off not only in cleaner revenue cycles but also in stronger compliance postures. In an era where payer audits are increasingly data‑driven, a consistent, well‑documented note is the best defense Still holds up..
In the long run, the goal is to align clinical reality with administrative language. Even so, when surgeons think in terms of “superficial versus deep” and coders translate that into 20670/20671 with appropriate modifiers, the entire workflow becomes more efficient. The complexity of sternal‑wire removal is therefore not a barrier but an opportunity to refine documentation habits that will benefit countless other procedures as well.
By embracing clarity, leveraging payer‑specific guidelines, and routinely reviewing coding outcomes, surgical teams can transform a seemingly minor detail—how a wire is removed—into a model of accurate, compliant billing practice Not complicated — just consistent..
