CPT Code for Sternal Wire Removal

If you are reading this, you or your team is likely dealing with a patient who has healed from open-heart surgery. Now, those sternal wires are causing problems. Maybe they are poking through the skin. Maybe they are causing persistent pain. Whatever the reason, the wires need to come out.

But here is the challenge. Finding the right CPT code for sternal wire removal is not always straightforward. You cannot just pick any removal code and hope for the best. The wrong choice leads to denials, lost revenue, and frustrated providers.

This guide will walk you through everything you need to know. We will look at the most common codes, when to use them, and how to document the procedure correctly. We will also discuss the nuances that separate a simple office procedure from a complex surgery.

Why Sternal Wire Removal Is a Unique Procedure

Sternal wires are used to close the breastbone after cardiac surgery. They are strong, stainless steel wires that twist together to hold the sternum stable while it heals. In most patients, these wires stay in place forever without any issues.

However, for some patients, the wires become symptomatic. The most common reasons for removal include:

• Wire migration or breakage

• Chronic pain at the sternotomy site

• Infection related to the hardware

• Palpable wires under the skin causing discomfort

• Wires eroding through the skin

When these problems occur, removal is the only solution. But the procedure varies widely. Sometimes the wires are superficial and easy to grab. Other times, they are deep, embedded in bone, or surrounded by scar tissue.

This variability is exactly why coding is complicated. There is no single “one size fits all” code.

The Core Codes You Need to Know

Let us start with the most relevant Current Procedural Terminology (CPT) codes. These are the codes you will consider when documenting sternal wire extraction.

These four codes are your main tools. But using them correctly requires careful attention to the procedure note.

When to Use 10120 for Sternal Wire Removal

Code 10120 is for simple removal of a foreign body from subcutaneous tissues. This means the wire is located just under the skin. The surgeon can feel it, see it, or both. The procedure involves a small incision, direct visualization of the wire, and simple extraction.

Real-world example: A patient presents with a palpable wire end pushing against the skin at the top of their sternotomy scar. The surgeon makes a 1 cm incision, grabs the wire with a hemostat, and pulls it out. The entire procedure takes 10 minutes.

In this case, 10120 is appropriate. The key factors are:

• Wire location: subcutaneous only

• No bone involvement

• Minimal dissection

• No general anesthesia required (often done with local)

Important note: Some payers may consider this a minor procedure. Check your local coverage determinations. Also, document the depth of the wire clearly.

When to Use 10121 for Sternal Wire Removal

Code 10121 is the complicated version of 10120. Use this when the wire is deeper than simple subcutaneous tissue or when the removal requires more than basic techniques.

What makes removal “complicated”? Several factors come into play:

• The wire is surrounded by dense scar tissue

• Multiple wires are present and intertwined

• The wire has broken, leaving fragments

• Significant bleeding occurs during the procedure

• The surgeon must dissect through muscle layers

Real-world example: A patient has sternal wires that are not visible or palpable. The surgeon makes a 3 cm incision, dissects through scar tissue and pectoral muscle, locates the wire deep in the wound, and removes it with specialized instruments. The procedure takes 45 minutes.

Here, 10121 is the better choice. Do not use 10120 just because the incision looks small. The effort and complexity matter.

When to Use 20680 for Sternal Wire Removal

This is where many coders get confused. Code 20680 is designed for removal of deep hardware. This includes pins, rods, plates, and wires that are embedded in bone or deep soft tissue.

For sternal wires, 20680 is appropriate when the wire is not just in subcutaneous tissue. If the wire has migrated into the sternum itself, or if the surgeon must remove hardware from within the bone, 20680 is your code.

Key distinction:

• 10120/10121 = foreign body in soft tissue

• 20680 = hardware in or on bone

Real-world example: A patient has a deep sternal wire infection. The wire is embedded in the sternal bone. The surgeon opens the previous incision, uses a wire cutter to cut the twisted ends, and pulls the wire out from deep within the bone tunnel. The wound is then irrigated and closed.

This is not a simple foreign body removal. This is deep hardware removal. Report 20680.

When to Use an Unlisted Code (20999 or Others)

Sometimes, none of the above codes fit. This happens when the removal is part of a larger procedure, or when the technique is unusual.

For example, if the surgeon performs a complete sternal rewiring and removal of all wires under general anesthesia with extensive debridement, an unlisted code may be necessary. You would report 20999 (unlisted procedure, musculoskeletal system) and submit the operative report with your claim.

Be aware that unlisted codes often trigger manual review. You will need to provide a cover letter explaining why no specific code applies. You can also compare the work to a similar code for pricing reference.

A Quick Decision Guide

To make this easier, here is a simple flow chart in text form. Ask these questions in order:

1. Is the wire in subcutaneous tissue only?

   • Yes → Go to question 2.

   • No (deep/bone) → Go to question 4.

2. Is the removal simple? (Minimal dissection, easy extraction, no complications)

   • Yes → Use 10120

   • No (complicated) → Use 10121

3. Is the wire embedded in bone or under the sternum?

   • Yes → Use 20680

   • No (deep soft tissue only) → Use 10121

4. Does the procedure involve extensive bone work or is it not described above?

   • Yes → Consider 20999 or other unlisted code

This decision tree is not official but reflects standard coding practices across many payers.

Documentation Requirements for Clean Claims

Good documentation is your best defense against denials. When coding for sternal wire removal, the operative note must include specific details. Here is what auditors look for:

Essential Elements in the Procedure Note

• Preoperative diagnosis: Why is the wire being removed? (Pain, infection, migration, etc.)

• Location: Which wire? Which level of the sternum?

• Depth: Subcutaneous, intramuscular, or intraosseous?

• Technique: How was the wire located? What instruments were used?

• Complexity: Was there excessive scar tissue? Fragmentation? Bleeding?

• Anesthesia: Local, regional, or general?

• Findings: Describe what the surgeon saw during the procedure.

• Specimen: Was the wire sent for culture or pathology? (Important for infection cases)

Example of Strong Documentation

“The patient is a 58-year-old male with persistent pain over the manubrium. Under local anesthesia, a 2 cm incision was made over the palpable wire end. Dissection was carried through subcutaneous tissue and into the pectoral fascia. The wire was found to be broken and surrounded by dense scar tissue. After sharp dissection, the wire fragment was grasped and removed. The wound was irrigated and closed in layers.”

This note clearly supports 10121 (complicated foreign body removal).

Modifiers and Billing Considerations

Sometimes you need more than just a code. Modifiers provide additional information to the payer.

Modifier 50 (Bilateral Procedure)

Sternal wires are midline. You cannot usually bill bilateral for a single incision. Do not use modifier 50 unless the surgeon removes wires from both sides of the sternum through separate incisions, which is rare.

Modifier 22 (Increased Procedural Services)

Use modifier 22 when the work is significantly greater than typical. For example, a 20680 removal that takes three hours due to extensive scar tissue and multiple broken wires.

You will need to document why the procedure was more difficult. Include time, effort, and any unexpected findings. Expect partial or full reimbursement above the base rate.

Modifier 59 (Distinct Procedural Service)

If the surgeon removes wires from two completely separate areas (e.g., upper sternum and lower sternum through different incisions), you might use modifier 59 on the second code. However, most payers expect a single code for all wires removed through the same approach.

Common Denial Scenarios and How to Avoid Them

Let us look at real-world denials. These happen more often than you might think.

Denial: “Procedure not medically necessary”

Why it happens: The medical record does not explain why the wires needed removal. Pain alone is not enough without details.

Solution: Document the specific symptoms. “Wire-related pain” is better than “pain.” Add that conservative measures failed. Include the duration of symptoms.

Denial: “Incorrect code used”

Why it happens: The coder used 10120 for a deep wire removal. The payer reviewed the op note and disagreed with the complexity level.

Solution: Be honest about the depth. If the wire is under muscle, do not use 10120. Use 10121 or 20680.

Denial: “Missing operative report”

Why it happens: The claim was submitted without supporting documentation for an unlisted code or modifier.

Solution: Always attach the operative note when using 20999 or modifier 22. Do not wait for the payer to ask.

Special Scenarios and Exceptions

Not every sternal wire removal fits neatly into a category. Here are some edge cases.

Removal During a Separate Thoracic Procedure

If the patient is already undergoing a thoracotomy or sternotomy for another reason (e.g., valve surgery), and the surgeon removes old wires as part of the exposure, you generally cannot bill separately for the wire removal. It is considered part of the primary procedure.

Removal Under Fluoroscopy or Ultrasound Guidance

Sometimes the wire is not visible or palpable. The surgeon may use imaging to locate it. In this case, you can report the removal code plus the appropriate guidance code (e.g., 76942 for ultrasound guidance). Check payer policies, as some bundle guidance into the removal code.

Removal of Infected Wires

Infection adds complexity. But the CPT code itself does not change based on infection status. Use the same code you would use for the depth and complexity. However, you may be able to bill for additional debridement codes (e.g., 11042 for wound debridement) if separate and distinct.

Important: Do not automatically bundle debridement. If the surgeon debrides non-viable tissue beyond the wire tract, that may be separately reportable.

Payer-Specific Policies You Should Know

Medicare and private insurers do not always agree. Here is what to watch for.

Medicare (National Coverage)

Medicare does not have a national coverage determination specifically for sternal wire removal. However, local contractors issue their own policies. Some LCDs (Local Coverage Determinations) explicitly state that 20680 is for hardware removal from bone. Others accept 10121 for subcutaneous wires.

Action step: Search for your state’s Medicare LCD for “Musculoskeletal System” or “Removal of Hardware.”

Commercial Payers

UnitedHealthcare, Cigna, Aetna, and others generally follow CPT guidelines. However, they may have internal policies. For example, some require preauthorization for 20680 but not for 10120.

Action step: Call the provider line or check the online policy manual for each major payer in your area.

A Note on Global Periods and Post-Operative Care

Most sternal wire removals are performed in the office or as outpatient surgery. But what about the follow-up?

• 10120 and 10121 typically have a 0-day or 10-day global period depending on the setting. Check the Medicare Physician Fee Schedule.

• 20680 usually has a 10-day global period. This means post-operative visits related to the procedure are included for 10 days. Do not bill separate E/M codes for routine follow-up during that time.

If the patient returns after the global period with a new problem (e.g., wound infection), you can bill a new E/M code with modifier 24 (unrelated evaluation during post-op period).

Real-World Coding Examples

Let us walk through three patient scenarios. Each one uses a different code.

Example 1: The Superficial Poking Wire

Patient: Mary, 72 years old. CABG (coronary artery bypass graft) performed 3 years ago. She notices a sharp wire end poking through her skin at the top of her chest. No redness or discharge.

Procedure: Under local anesthesia, the surgeon grasps the wire with a hemostat and pulls it out. A single stitch is placed.

Coding: 10120

Rationale: Subcutaneous foreign body. Simple removal. No dissection through muscle.

Example 2: The Deep Painful Wire

Patient: James, 55 years old. Heart transplant 2 years ago. Chronic midline pain. No wire visible. X-ray shows intact wires but one appears slightly migrated.

Procedure: Under general anesthesia, the surgeon reopens the upper 4 cm of the old incision. Dissects through scar and pectoral muscle. Locates the wire, cuts it, and removes it. Closure in layers.

Coding: 10121

Rationale: Complicated removal. Dissection through muscle and scar. General anesthesia required.

Example 3: The Infected Deep Wire

Patient: Linda, 68 years old. Aortic valve replacement 18 months ago. Presents with drainage from the lower sternum. CT shows osteomyelitis of the sternum around a wire.

Procedure: Under general anesthesia, the surgeon removes the infected segment of bone and the embedded wire. The wire is cut and extracted from the bone tunnel.

Coding: 20680

Rationale: Hardware removal from bone. Deep location. Not a simple foreign body.

How to Write a Bulletproof Operative Report

Your coding is only as good as your documentation. Here is a template you can adapt.

Preoperative Diagnosis: Symptomatic sternal wire, [specific location].

Postoperative Diagnosis: Same.

Procedure Performed: Removal of sternal wire.

Anesthesia: [Local / MAC / General]

Indication: [Patient name] is a [age]-year-old [male/female] who underwent cardiac surgery on [date]. They present with [pain / wire erosion / infection] localized to the [upper/middle/lower] sternum. Conservative management has failed.

Description of Procedure:
The patient was placed in the supine position. The previous sternotomy scar was prepped and draped in sterile fashion. Local anesthesia with 1% lidocaine was infiltrated.

A [length] cm incision was made over the [palpable/radiographically localized] wire. Dissection was carried through subcutaneous tissue. [Add if applicable: The pectoralis major muscle was identified and divided sharply.]

The wire was found to be [intact / broken / embedded in scar]. It was located [specify depth]. Using a [hemostat / wire cutter / needle driver], the wire was grasped and removed in [one piece / multiple fragments].

The wound was irrigated with normal saline. Hemostasis was achieved with [electrocautery / pressure]. The incision was closed with [suture type and size]. Sterile dressings were applied.

Estimated Blood Loss: [amount]

Complications: None / [describe if any]

This structure gives a coder everything needed to assign the correct CPT code.

Frequently Asked Questions (FAQ)

Q1: Can I bill for sternal wire removal and an office visit on the same day?
Yes, if the decision to remove the wire was made during a separate, significant evaluation. Append modifier 25 to the E/M code. Document that the visit was medically necessary and distinct from the procedure.

Q2: What if the surgeon removes 5 wires at once?
You still report one code. The code represents the procedure, not the number of wires. Do not bill for each wire separately.

Q3: Is there a specific CPT code for endoscopic sternal wire removal?
No. There is no dedicated endoscopic code. You would use 10121 or 20680 depending on depth, and document the endoscopic approach. Some coders add modifier 22 for the increased complexity.

Q4: Does Medicare cover sternal wire removal?
Yes, when medically necessary. Common covered indications include infection, wire migration with skin erosion, and chronic pain unresponsive to conservative care. Cosmetic requests are not covered.

Q5: How do I code wire removal when done in the emergency department?
The same codes apply. Use 10120, 10121, or 20680 based on the procedure performed. Do not use an emergency department E/M code for the procedure itself. That is included in the CPT procedure code.

Q6: What if the wire is removed in the office without an incision?
Rare. If a wire spontaneously erodes through the skin and is simply pulled out without any incision, you cannot bill a surgical code. You might bill an E/M code for the evaluation, but the removal itself is not separately reportable.

Q7: Do I need a separate consent for wire removal during another surgery?
Best practice is yes. The consent form should mention sternal wire removal specifically, even if it is a minor part of the larger operation.

Additional Resources

For further reading and official guidance, bookmark these trusted sources:

• American Medical Association (AMA) CPT® Professional Edition – The official codebook. Do not rely on online summaries alone.

• American College of Surgeons (ACS) – Coding and Reimbursement – Offers specialty-specific advice for thoracic and cardiac surgeons.

• Centers for Medicare & Medicaid Services (CMS) – Physician Fee Schedule Lookup Tool – Check global periods and reimbursement rates for each code in your region.

• Local Coverage Determination (LCD) Search on CMS.gov – Enter your state and search for “removal of hardware” or “foreign body removal.”

👉 Recommended Link: CMS.gov – Medicare Coverage Database – Use this to find official LCDs for your area.

Final Thoughts on Choosing the Right CPT Code

You now have a solid framework. Remember the golden rule: Depth determines code.

• Subcutaneous and simple → 10120

• Subcutaneous but complicated (scar, muscle, fragmentation) → 10121

• In or on bone → 20680

• No match → Unlisted (20999)

Do not guess. Do not assume. Read the operative note as if you were the auditor. If the note does not clearly support the code, ask the provider to add an addendum before you submit the claim.

Sternal wire removal is generally a safe, effective procedure. Correct coding ensures the surgeon is fairly reimbursed and the patient’s record accurately reflects the work performed. When in doubt, reach out to your local medical society or a certified professional coder.

Conclusion

Choosing the correct CPT code for sternal wire removal depends entirely on the depth of the wire and the complexity of the extraction. Simple subcutaneous removals use 10120, while deep or bone-embedded wires require 10121 or 20680. Always document thoroughly and check payer-specific policies to avoid denials.

Disclaimer

This article is for educational and informational purposes only. It does not constitute legal, medical, or billing advice. CPT codes and payer policies change frequently. Always consult the current AMA CPT manual and your local payer guidelines before submitting any claim. The author and publisher disclaim any liability for any adverse outcomes resulting from the use of this information.