Neurosurgery Coding Alert

Question: When placing bone grafts (for example, 20931), should I charge separately for shaping the graft?

Washington Subscriber

Answer: There is no separate code to report shaping. Codes 20930-20938 describe placement of bone grafts, which are classified as either autograft or allograft. An autograft is taken from a patient for transplantation elsewhere on the same patient's body (for instance, bone is taken from a rib to complete a spinal fusion). An allograft comes from a cadaver or living donor, and is frozen or freeze-dried and kept in a surgical or regional bone bank until needed.

Codes 20930 (Allograft for spine surgery only; morselized) and 20931 ( structural) describe only placement of the graft, while 20936-20938 include placement and harvesting. All codes include shaping, if necessary. If the graft is taken from the same skin and fascial incision as that used to access the spine for repair, 20936 (Autograft for spine surgery only [includes harvesting the graft]; local [e.g., ribs, spinous process or laminar fragments] obtained from same incision) is appropriate (occasionally iliac bone graft is harvested through a separate fascial incision during lumbar surgery). If the physician must make a separate skin or fascial incision to obtain the graft, 20937 ( morselized [through separate skin or fascial incision],for a morselized graft) or 20938 ( structural, bicortical or tricortical (through separate skin or fascial incision], for a structural graft) is appropriate.