Medicare Compliance & Reimbursement

Question: What's the difference between a spinal allograft and an autograft?

Answer: If the surgeon harvests bone from the patient's own body, you'll code for an autograft with one of the following codes:

• +20936 -- Autograft for spine surgery only (includes harvesting the graft); local (e.g., ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure)
• +20937 -- ... morselized (through separate skin or fascial incision) (List separately in addition to code for primary procedure)
• +20938 -- ... structural, bicortical or tricortical (through separate skin or fascial incision) (List separately in addition to code for primary procedure).

Example: The surgeon removes a portion of bone from the patient's rib through the same thoracic spinal exposure site, reshapes the bone as necessary, and grafts it onto the spine for reconstruction. For this autograft, report +20936 along with the code for the primary surgical procedure.

The bone the surgeon uses during an allograft, however, comes from another human donor. When the surgeon performs an allograft, he'll also use synthetic applications. For allografts, report one of these codes:

• +20930 -- Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure)
• +20931 -- ... structural for spine surgery only (List separately in addition to code for primary procedure).

Allograft clue: If operative notes indicate that the bone came from a bone bank, you'll automatically choose an allograft code.