# Reconstruction of Bone Graft Site



## m.newman (May 12, 2009)

Dr performed subtalar arthrodesis with bone graft harvested from iliac crest. He also indicates iliac crest reconstruction, can this be coded/billed separately?  This is excerpt from op report:

"Attention was then turned to the left iliac crest which was palpated. An incision was made 1 cm proximal to the anterior superior iliac spine. Electrocautery was used for hemostasis.  The fascia was then incised over the anterior iliac crest.  The muscle was elevated off the inner and outer tables with an elevator. A tricortical graft was then obtained with a sagittal saw and osteotome.  _Gelfoam and thrombin was then placed into the iliac crest after scooping out cancellus bone graft with a rongeur.  The wound was then copiously irrrigated.  MacroPore was then contoured to fit over the iliac crest defect and held in place with 3 reabsorbable pins._ The Jackson-Pratt drain was then placed deep in the wound, superficial to the outer table, and brought out through a separate stab incision.  The fascia was then closed with interrupted #1 vicryl sutures.  THe deep subcutaneous tissue was closed with 0 vicryl interrupted sutures. Staples were used to close the skin.  Attention was then turned back tot he left subtalar nonunion......"

Can the reconstruction of the iliac crest be billed separately?  If so, what code (unlisted 27299?)?

Any thoughts or suggestions would be greatly appreciated?

Thank you.
Maryanne


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## Bella Cullen (May 12, 2009)

For the bone graft I would use 20900 or 20902 as a separate billable procedure.


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## m.newman (May 12, 2009)

Yes, I will be using 20902 for the bone graft. 

My question is if the "Reconstruction of the Iliac Crest" can be coded separately.


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## Bella Cullen (May 12, 2009)

I would say no because they have to do some kind of closure to that area since that is where they took the bone graft.


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## m.newman (May 13, 2009)

Dr still feels what he did was outside of the norm for the reconstruction of the graft harvest site.

Has anyone come across this or similar situation?


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