# Frustrated about Xenograft Bone!



## PatriciaCPC (Apr 26, 2008)

I hope someone if familiar with this.. I am totally frustrated   about finding the most appropriate code for Xenograft bone! 
- 'Mr Complicated'  had "Xenograft bone placed to fill in removal of hardware areas". 

*Femur 9x25
*Tibia 8x25

The only code I can come up with is: _15430 'Acellular xenograft implant; first 100 sq cm or less, OR 1% of body area of infants and children"_
Is this correct??
I am having a difficult time deciphering as Ingenix states: "Acellular xenograft implants are used to fill soft tissue voids following surgical or traumatic injuries, to reconstruct acquired or congenital _defects of the skin and soft tissues_, to reconstruct the pelvic floor, and to augment tissue for cosmetic enhancement." HOWEVER... ALSO STATES: "_Other uses _of acellular xenograft implants are being tested."
Do you think other uses means I can use this for 'bone'?? 
Any info provided is greatly appreciated as always!


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## kevbshields (Apr 27, 2008)

Check out 20900, 20902.  I do not suspect it makes any difference that this bone is "Xenograft".  Really, that information is moot to the overall service which is removal of hardware (206XX) and repair of defect (2090X).

Hope this helps some.  These can be confusing, but the other codes listed are meant for skin/tissue grafts.  

Good luck.


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## Frosty (Apr 29, 2008)

I'm confused.  Was this done at the same time as the hardware removal?  If so, wouldn't placement of the xenograft be included with the hardware removal the same as if it were allograft?  Also, I disagree with using 20902 as I believe that is for autografts only(taken from the same patient).  Xenograft is from another species.  Maybe I'm missing something.


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## kevbshields (Apr 29, 2008)

Oops!

Marge is right (thanks for pointing that out--Yikes).  Those bone grafts are autologous only.

However, I don't believe any grafts would be included in the code descriptors for the removal of the fixators . . . those are very, very basic procedures where the physicians typically (in my experience) do not use bone grafts in conjunction.  

However, I'm at a real loss for the exact code for the service.

Sorry!


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## emeskina (Apr 30, 2008)

*Heads up*

AAOS states the following is included in the global service package for 20680

preparation and insertion of synthetic bone substitutes, osteoconductive and osteoinductive agents (eg, hydroxyapatite, calcium phosphates, coral, methylmethacrylate, demineralized bone matrix, bone morphogenetic proteins), except where specifically excluded (eg, 20930, 20931)


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## kevbshields (Apr 30, 2008)

Xenografts do not appear to fit into those categories though.

I suppose we're back to square one . . .


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## Frosty (Apr 30, 2008)

I didn't see any mention of it being "ex-fix" removal.  Was it that or was it deep hardware & was the graft placed at the same time as the hardware removal?  And I don't know the answer as to whether xenograft falls into the same category as allograft (as far as being included in the hardware removal) - if it's no more work than placing allograft, then I don't see the difference.  Just don't know...


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