??? We are billing as a proc for a knee and we have contracts with the payers that pay the implants as 50% of charges. Note that all of the above codes include harvesting of the bone, which is not separately reported, as well as shaping or preparation of the graft, prior to placement. In ICD-10-PCS coding the type of bone graft product is represented with the 6th character (device) of the fusion code. Example: 29888 - ACL Repair G0289 - Arthroscopy, knee, surgical, for removal of loose body, Harvesting and inserting the graft is included in code . Tibial Tunnel Bone Allograft Cpt Code For The. My surgeon disagrees with me and is firm that the harvest of the bone graft is not separately reportable. Morselized bone grafts are small pieces of bone used to pack defects and to promote new bone growth. It may not display this or other websites correctly. Do not report +20932 with 20933, 20934, 23200, 24152, 27078, 27090, 27091, 27448, 27646, 27647, and 27648. Here are the CPT codes for bone grafts: 21215 - Graft, bone; mandible (includes obtaining graft) 21210 - Graft, bone; nasal, maxillary or malar areas (includes obtaining graft) The modifier -52 can be used when bone is not obtained from the patient. Shouldnt we be able to report the bone graft in addition to 25431 because of the separate incision? *This response is based on the best information available as of 2/28/19. Copyright 2022, AAPC . A structural bone graft is a single piece of bone, which provides direct support for skeletal structures. clavicle, with or without internal fixation; with bone graft for nonunion or malunion (includes obtaining graft and/or necessary fixation) 23490 Prophylactic treatment (nailing, pinning, plating or wiring) with or without . Low-cost skin . Codes 20930 and 20931 are used to identify this procedure. Code+20934 may be reported with primary tumor removal procedures 23210, 23220, 24150, 25170, 27075, 27076, 27077, 27365, 27645, and 27704. For a morselized autograft, choose 20937. Multiple . Allograft Cpt Code ACL Reconstruction with a Bone Patellar Tendon Bone BPTB. CPT : CPT Long Description: 20600 : ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; SMALL JOINT OR BURSA (EG,FINGERS, TOES) Threaded bone dowels are an exception: Per CPT Assistant (February 2005), Threaded bone dowel is the only bone allograft that would qualify for code 22851 [Application of intervertebral biomechanical device(s) (eg, synthetic cage(s), methylmethacrylate) to vertebral defect or interspace (List separately in addition to code for primary procedure)]. Osteochondral allograft of talus: CPT codes not covered for indications listed in the CPB: 20962: Bone graft with microvascular anastomosis; other than fibula, iliac crest, or metatarsal: 28103: Excision or currettage of bone cyst or benign tumor, talus or calcaneus; with allograft: Other CPT codes related to the CPB: 28705 - 28725 Is the Bone Graft from the Patients Own Body? The procedure includes sizing and shaping of the bone allograft, as well as placing and securing it; however, you may separate report insertion of joint prosthesis, if performed. codes diagnosis. For a better experience, please enable JavaScript in your browser before proceeding. acl,reconstruction,with,allograft,cpt,code Created Date: 12/11/2022 4:20:39 AM . It may not display this or other websites correctly. Bone bank bone is not reported using these codes. CPT HCPCS; CDT (dental) ICD-10-PCS; LOINC NEW; SNOMED CT . . The bone graft codes 20900 and 20902 are separately reportable only when the graft material is an autograft and is obtained through a separate incision and not listed as part of the basic procedure. CPT code 20225-Biopsy, bone, trocar, or needle; deep (eg, vertebral body, femur) A new instruction note has been added: "For bone marrow biopsy(ies) and/or aspiration(s), see 38220, 38221, 28222". 2021 Evaluation and Management Codes: Is a History and Exam Required? You are using an out of date browser. As a minimally manipulated human tissue graft, the Chondrofix Osteochondral Allograft undergoes a proprietary processing protocol resulting in a shelf-stable graft that retains relevant inherent structural properties and provide. ACL Reconstruction BTB Graft Knee amp Sports . CPT code for an ASC-covered procedure is assigned a relative weight and flat payment amount which is then adjusted for the ASC setting. Bone and Tendon Graft Substitutes and Adjuncts Medical. DeNovo NT Natural Tissue Graft Coding Reference Guide. For a structural allograft, report 20931. I thought about C1762, but would bone be considered connective tissue??? May 1st, 2018 - Cpt Code For Acl Reconstruction With Allograft Acl reconstruction with allograft vs autograft aapc i would really appreciate your assistance with clarification when an acl reconstruction is performed 29888 is the Title: Acl Reconstruction With Allograft Cpt Code Author: newsletter.lufo.lu.se-2022-12-08-11-11-24 Subject: Acl Reconstruction With Allograft Cpt Code Hospital Outpatient Coding (APCs) Ambulatory payment classifications (APCs) is the prospective payment system Medicare uses to reimburse hospitals for outpatient services. Privacy Policy | Terms & Conditions | Contact Us. Code +20932 is an add-on code that may be reported with primary tumor removal edures 23210, 23220, 24150, 25170, 27075, 27076, 27077, 27365, 27645, and 27704. Bone harvested from the patients own body is known as an autograft. For spinal grafts, the applicable autograft codes are: +20936 Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure) Do not report with 20932, 20933, 20955, 20956, 20957, 20962, 23146, 23156, 23200, 24116, 24126, 24152, 25126, 25136, 27078, 27090, 27091, 27130, 27132, 27134, 27138, 27236, 27244, 27356, 27448, 27638, 27646, 27647, 27648, 28103, or 28107. Earn CEUs and the respect of your peers. KarenZupko & Associates, Inc. 2022 | All Rights Reserved, Secondary Payor Doesnt Recognize Consultations. I have searched everywhere & cannot find any guidance on this issue. jennburgel.Are you being reimbursed for the C1762 when it's billed by an ASC facility??? Do not append modifier 62 to bone graft codes 20900-20938. It's paid for under the resources used by the facility. D4263 Bone replacement: First site in quadrant - Procedure involves the use of osseous autografts, osseous allografts, or nonosseous grafts to stimulate bone formation or . Tech & Innovation in Healthcare eNewsletter, Excision of Benign or Malignant Skin Lesion, Becker's Orthopedic & Spine Review: 5 Strategies for Sustaining a Successful Orthopedic Practice, Gain Solid Footing for Orthopedic E/M Coding, Check Bundles When Coding Cam/Pincer Lesions. CPT code information is copyright by the AMA. i-FACTOR Bone Graft is an advanced biologic that is supported with level I evidence, satisfies the highest regulatory imperatives, and provides a better cost/benefit ratio than engineered growth factors and cellular allografts. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. Patients who underwent ACL reconstruction (Current Procedural Terminology (CPT) code 29888) between 20 were identified using the PearlDiver database. Coding Tip! I need to know the correct HCPCS code a hospital would use to bill for a structural bone allograft - not morselized, a solid piece of bone. Code +20932 is an add-on code that may be reported with primary tumor removal edures 23210, 23220, 24150, 25170, 27075, 27076, 27077, 27365, 27645, and 27704. Bone Graft February 28, 2019 Question: My surgeon performed a repair of a nonunion with bone graft harvested via a separate incision. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. KarenZupko & Associates, Inc. | 312.642.5616 | information@karenzupko.com. ICD-10-CM/PCS. i-FACTOR Bone Graft is the only biologic bone graft made of a small peptide, P-15 Osteogenic Cell Binding Peptide, bound to an anorganic bone mineral (ABM). For example, when a surgeon performs a subtalar arthrodesis defined by CPT code 28725 (Arthrodesis; subtalar) and harvests a bone graft from the proximal tibia, both 28725 and the bone graft (e.g. Typical CPT Codes. 1. 27702 - Reconstruction of ankle joint. 27899 - Unlisted procedure, leg or ankle. registered for member area and forum access. #1 I need to know the correct HCPCS code a hospital would use to bill for a structural bone allograft - not morselized, a solid piece of bone. Anti-microbial bone graft substitutes - no specific code: ICD-10 codes not covered for indications listed in the CPB: M86.9: Osteomyelitis, unspecified: Bone micro-indentation testing: CPT codes not covered for indications listed in the CPB: 0547T: Bone-material quality testing by microindentation(s) of the tibia(s), with results reported as a . Allograft Skin CPT Codes. on Spinal Bone Graft Coding, as Easy as 1, 2, 3, Spinal Bone Graft Coding, as Easy as 1, 2, 3, Tech & Innovation in Healthcare eNewsletter, Excision of Benign or Malignant Skin Lesion, Intrafacet Implant Doesnt Bundle Open Approach Arthrodesis, Complete Spinal Fusion Coding Includes Grafting and More, Watch How You Code for Facet Joint Injections. It is a dental treatment process done to protect your bone levels after a tooth is taken out. You must log in or register to reply here. + 20934 intercalary, complete (ie, cylindrical) (List separately in addition to code for primary procedure). For a better experience, please enable JavaScript in your browser before proceeding. For a morselized allograft, select 20930. Wheres the Incision? NPM Knowledge Base Medical Billing in Dentistry Guides CPT code for bone graft Medical CPT (proedure) codes for dental practices to use for medically necessary bone grafts 21210 - graft, bone; nasal, maxillary, or malar areas 21215 - graft, mandibular **use modifier -52 for reduced services when bone is not obtained from patient 28107 - Excision of bone cyst or benign tumor, tarsal or metatarsal. Earn CEUs and the respect of your peers. I believe C9359 is for the injectable putty & C9362 is for the moldable putty, but what do you use for a structural bone allograft? unless the code descriptor references the harvesting of the graft or implant (eg, includes obtaining graft)". +20938 Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision) (List separately in addition to code for primary procedure). Privacy Policy | Terms & Conditions | Contact Us. Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, without bone graft C . The bone graft is the material used that will allow a bridge between two vertebral segments in the spine, resulting in spinal . He is an alumnus of York College of Pennsylvania and Clemson University. The bone utilized for the case in question is an allograft. For a structural autograft, select 20938. +20931 Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure). This unique . Like 20936-20938, the allograft codes include shaping or preparation of the graft material. n I would assume you could bill for both the procedure and the implant. CPT Codes: Common Procedures : 23472: . In Part 6, we are going to focus on identifying the type of bone graft used for the spinal fusion. Question: Bonus Tip: Multiple Grafts and Modifiers When coding for spinal autograft only, you must also determine whether the bone for the graft is harvested from the same site into which the graft will be placed, or from a separate site. Chondrofix Osteochondral Allograft is a decellularized allograft consisting of hyaline cartilage and cancellous bone. Bone graft, any donor area; minor or small (eg, dowel or button) 20680: Hardware Removal: . Code +20933 may be reported with primary tumor removal procedures 23210, 23220, 24150, 25170, 27075, 27076, 27077, 27365, 27645, and 27704. The surgeon submitted CPT code 25431 alone. 2021 E/M Guidelines and Consultation Codes, Two Orthopaedic Surgeons, Two Separate Surgeries, Category III Codes Effective July 1, 2022, Fee Setting: Category III Codes or Unlisted Procedures, Teaching Physician Rules Related to E&M Code Selection, Interposition Arthroplasty CMC Joint Denial. I thought about C1762, but would bone be considered connective tissue?? My surgeon performed a repair of a nonunion with bone graft harvested via a separate incision. Is the Graft Structural or Morselized? The procedure includes sizing and shaping of the bone allograft, as well as placing and securing it; however, you may separate report insertion of joint prosthesis, if performed. If you can master basic terminology and identify within documentation the answer to three key questions, you can accurately apply spinal bone graft codes. Bone Graft for Congenital, Traumatic, or Surgical Defects of Facial Bones D7955, Repair of Maxillofacial Soft Tissue and/or Hard Tissue Defect D7295, Harvest of Bone for Use in Autogenous Grafting Procedures Barrier Membranes D3432, Guided Tissue Regeneration - resorbable barrier, per site, in conjunction with periradicular surgery. D7953 is the dental code used for Bone Replacement Graft for Ridge Preservation. You are correct that if a graft is obtained via a separate incision and is not inclusive to the code definition, or is not inclusive to a typical procedure, that the bone graft may be reportable in addition to the primary procedure. You must log in or register to reply here. HCPCS Level II Coding Reference Guide. CPT code 25431 (Repair of nonunion of carpal bone (excluding carpal scaphoid (navicular)) (includes obtaining graft and necessary fixation), each bone) states in its definition the instructions includes obtaining graft and necessary fixation). I reviewed CPT 20900 but thought not to bill because it states 'autogenous' bone graft/harvest. CPT Code Defined Ctgy Description 23900 Interthoracoscapular amputation (forequarter) 23920 Disarticulation of shoulder; . Allograft skin for temporary wound closure, trunk, arms, legs; first 100 sq cm less, or 1 per cent of body area of infants and children (15300) Allograft skin for temporary wound closure, trunk, arms, legs; each additional 100 sq cm, or each additional 1 per cent of body area of infants and children, or part thereof . AmnioRepair Allograft Coding Reference Guide AmnioRepair Allograft is a lyophilized placental membrane allograft that is aseptically processed to preserve the native extracellular matrix and endogenous proteins. When the surgeon harvests and places the bone via the same incision, select the local autograft code, 20936. AmnioRepair is indicated for use as a biological barrier or wound cover. we bill the c1762 as the implant code at the ASC facility level in order to be paid for the implant itself. Chondrofix Osteochondral Allograft Coding Reference Guide. I added CPT code 20902 after reviewing the operative note, because the surgeon obtained the bone graft from a distant site via a separate incision. He is an alumnus of York College of Pennsylvania and Clemson University. Does anybody have any insight into C1762 being billed in the professional setting in conjunction with an LESI and SI joint injections? Code +20933 describes partial (hemicylindrical) bone allograft, while +20934 describes complete (cylindrical) allograft. The 2019 CPT codebook introduced three new, add-on codes to report bone allograft: + 20932 Allograft, includes templating, cutting, placement and internal fixation, when performed;osteoarticular, including articular surface and contiguous bone (List separately in addition to code for primary procedure) CODING ARTHROSCOPIC KNEE PROCEDURES Find A Code Articles. Here are the CPT codes for implants: John Verhovshek, MA, CPC, is a contributing editor at AAPC. 27700 - Revision of ankle joint. The bone allograft is supplied by the facility so the physician cannot bill for it. The spinal allograft codes are: +20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure) Access to this feature is available in the following products: Find-A-Code Essentials. Do not report with 20932, 20934, 23200, 24152, 27078, 27090, 27091, 27448, 27646, 27647, or 27648. CPT Assistant (April 2012) instructs, When more than one type of bone graft is required, the appropriate code(s) from the 20930-20938 series are reported only once per operative session, regardless of the number of vertebral levels being surgically fused (i.e., not once per spinal interspace or segment fused). For this same reason, you should never append modifier 50 Bilateral procedure to bone graft codes 20930-20938. Answer: Read the "DecisionHealth" newsletter article titled: "2019 CPT code changes: Look for detailed coding instructions for new bone allograft codes " - Subscription required. Nevermind - I have answered my own question. 28120 - Partial talectomy. As with +20932, intercalary allografts +20933 and +20934 include sizing, shaping, placement, and securing of the graft. These allografts are positioned between joints (i.e., intercalary). N/A ; N/A . And, because 209930-20938 are add on codes, you would never report them with modifier 51 Multiple procedures appended. Description Allograft is the obtaining of a bone graft from a cadaver donor that is either frozen or freeze-dried until used. Unlisted Procedure Codes - Frequently Asked Questions. When the bone is harvested from a different incision, or when using allografts, you must answer an additional question. CPT Code Description Internal Fixation (cont.) I have found quite a bit of information about this code being billed in OPPS setting, but not at the professional level. 3. 28103 - Excision of bone cyst or benign tumor, talus or calcaneus; with allograft. I believe C9359 is for the injectable putty & C9362 is for the moldable putty, but what do you use for a structural bone allograft? If both allografts and autografts are used, it is best practice to bill an autograft code from the graft section, as the allografts are already being billed with code L8699 for purchased implants. CPT Codes and Descriptors CPT Description FacilityHospital Outpatient ASC Payment Physician SI* APC Payment MPFS . If this is your first visit, be sure to check out the. I have the same question. CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more. Although your physician did do the work of harvesting the bone graft from a separate incision, the rules associated with this code do not allow reporting 20902 (Bone graft, any donor area; major or large). The extent of the procedure is determined by provider documentation. I've also thought about L8699 but I wouldn't consider this a "prosthetic" implant - it's a human bone graft. N/A ; 21143 ; Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, without bone . 28420 Open treatment of calcaneal fracture, includes internal fixation, when performed; with primary iliac or other autogenous bone graft (includes obtaining graft) 28445 Open treatment of talus fracture, includes internal fixation, when performed when performing an ORIF of metacarpal fracture with the use of bone allograft, is the bone allograft separately reportable and if so, what code should be billed? Thanks for bring that to my attention PLASTICSCPT, I only went by the Cpt book and it does not address what type of bone donor, it only said, any donor, so after I read your message, I went on my Ingenix program and looked at the Lay terminology definition and saw Autograft. The spinal allograft codes are: +20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure) +20931 Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure) Shoulder and Elbow Codes . Orthopedic Coding Peek . JavaScript is disabled. Download baros daca maine ft bogdan ioana jibovivawosac cf. D dclark7 True Blue Messages 723 Location Hartford, CT Best answers 0 Nov 18, 2011 #5 If the bone for the graft comes from a bone bank or donor other than the patient, it is an allograft. 20900 or 20902) may be reported. Please help!! Bone graft, any donor area; minor or small eg, dowel or button) (20900) Bone graft, any donor area; major or large (20902) Cartilage graft; costochondral (20910) Fascia lata graft; by stripper (20920) Fascia lata graft; by incision and area exposure, complex or sheet (20922) Tendon graft, from a distance eg, palmaris, toe extensor, plantaris . Bone graft material may come from a number of sources: the individual's own bones (autograft), a bone bank (allograft), demineralized bone matrix or bone graft subs. I added CPT code 20902 after reviewing the operative note, because the surgeon obtained the bone graft from a distant site via a separate incision. Bone grafts may be used in the treatment of delayed fracture unions, in spinal fusions, to bridge major bone defects or fill cavities created by tumor removal, cysts or other causes. we can take C1762 for the bone allograft. As a contributor you will produce quality content for the business of healthcare, taking the Knowledge Center forward with your knowhow and expertise. Check with your payer to determine if 20930 can be billed separately or if the application of the bone graft material is included in the code for the primary surgical procedure. JavaScript is disabled. What did you come up with? Use code 20930 for a morselized allograft that is purchased or code 20931 for a . + 20933 hemicortical intercalary, partial (ie, hemicylindrical) (List separately in addition to code for primary procedure) described by CPT codes 15271-15278. We are looking for thought leaders to contribute content to AAPCs Knowledge Center. The physician prepares this graft using cancellous chips (morselized), and then inserts it in the spine, as a separately reportable spinal procedure. Bone Graft related CPT Codes Bone Graft related CPT Codes Bone graft, any donor area; minor or small eg, dowel or button) (20900) Bone graft, any donor area; major or large (20902) Insertion vascular pedicle into carpal bone (25430) Bone marrow; aspiration only (38220) Bone marrow transplantation; autologous (38241) Microvascular +20937 Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial incision) (List separately in addition to code for primary procedure) As a contributor you will produce quality content for the business of healthcare, taking the Knowledge Center forward with your knowhow and expertise. Thanks for replying Tonya. ? You are using an out of date browser. Question: I oftentimes bill and E/M code with modifier 25 for an office visit and 92504-50 (1 unit) for the binocular microscopy to Medicare. registered for member area and forum access. Copyright 2022, AAPC An osteoarticular bone allograft (20932) consists of bone, articular (joint) cartilage, and other soft tissues that is used to replace large defects, such as those caused by excision of a bone tumor involving adjacent tissue, including cartilage and tendons. Bone Graft related CPT Codes Bone Graft related CPT Codes Bone graft, any donor area; minor or small eg, dowel or button) (20900) Bone graft, any donor area; major or large (20902) Insertion vascular pedicle into carpal bone (25430) Bone marrow; aspiration only (38220) Bone marrow transplantation; autologous (38241) Microvascular PCL Reconstruction 29889 eORIF. . ICD-10-CM/PCS Frequently Asked Questions. Code 20930 is an add on code and used for specified spinal procedures only. You may report a maximum of one unit of any spinal bone graft code, per session, even if the surgeon places multiple spinal bone grafts. The surgeon submitted CPT code 25431 alone. That's what I get for going by Cpt book only. ICD-10-CM; DRGs; HCCs; ICD-11 NEW; SNOMED CT NEW; ICD-9-CM; procedures. UpToDate. Only one bone graft code from this section can be billed per case. We appreciate your question! 20900 - CPT Code in category: Bone graft, any donor area. John Verhovshek, MA, CPC, is a contributing editor at AAPC. 2. HCPCS Level II. If this is your first visit, be sure to check out the. WITH A "BONE PATELLAR TENDON BONE" GRAFT HAS THE ADVANTAGE OF BETTER OUTCOMES WHEN COMPARED TO OTHER FORMS OF THERAPY OR OTHER GRAFTS AND THE PATELLAR GRAFT IS ALSO EASILY OBTAINED Per CPT instructions, you should not append modifier 62 Two surgeons to bone graft codes 20930-20938. An allograft is tissue taken from one person for use in another person. . Intercalary allograft transplantation (+20933 and +20934) also uses human tissue to reconstruct bone defect(s) after tumor resection. We are looking for thought leaders to contribute content to AAPCs Knowledge Center. Bone Graft code it. 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