Hardware removed as part of revision

Read an original fictional chart, identify the supported facts, and explain your coding workflow.

Chart gym · Original fictional record

Service date: 2026-09-09 · Medicare musculoskeletal professional service

Use your code books and write your reasoning before opening the walkthrough. This exercise contains no real patient information.

Operative indication

A fictional adult has a documented nonunion at a previously treated fracture site. The surgeon plans revision at that same site. The prior fixation remains in place and obstructs the work needed for the revision.

Procedure sequence

The surgeon exposes the area, removes the existing plate and screws as a necessary component of the revision, then completes the documented revision procedure. The hardware is not removed from a separate unrelated anatomical site.

Service relationship

The operative note explains why the hardware had to be removed to complete the new work. There is no separately performed elective removal encounter. Multiple devices and an itemized inventory are documented, but those details do not alone establish multiple procedure units.

Coding question

A proposed claim adds independent hardware-removal procedures for each screw and the plate to the revision. Review both the integral-service relationship and the distinction between device count and anatomical-site units. The exact revision entry requires the full current operative-family lookup.

Your coding worksheet

Identify why hardware removal occurred.
Link it to the revision at the same site.
Evaluate the proposed independent removal lines.
State what the current revision lookup still needs.

In your notebook, record the supported facts, your index route, the instructions you checked, and any missing detail that limits your answer.

Compare with the worked explanation

Removal is necessary to complete the same-site revision.
That is an integral component relationship, not an unrelated removal service.
NCCI does not support separate removal lines for that included work, and device count is not independently a unit rule.
Complete the exact revision entry from the actual anatomical site and procedure details; do not infer a code solely from the word nonunion.

Reference sections: G.10

Practice the linked chart questions