Neurosurgery Coding Alert

You needn't worry about NCCI Edits with most bone graft/spinal fusion combinations Although CPT and the National Correct Coding Initiative (NCCI) bundle bone grafting into some surgical procedures, you can safely report 20930-20938 with most spinal arthrodesis and instrumentation codes, which can yield you as much as $200 more per claim. Don't Let Payer Misunderstanding Affect Your Payment When coding for spinal fusions (22548-22812) and/or instrumentation placement (22840-22855) with bone grafts (20930-20938), you should separately report (and expect separate payment for) the grafting procedures, says Eric Sandham, CHC, CPC, compliance manager for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno. (See page 35 for a full description of spinal fusion, instrumentation and bone graft codes.)
 
Although CPT and NCCI bundle bone grafts to many orthopedic procedures (for example, 23480, Osteotomy, clavicle, with or without internal fixation ), these bundles do not apply to arthrodesis (22548-22812) and spinal instrumentation (22840-22855) procedures.

Take action on bundled claims: Because many payers are familiar with bundling bone graft codes, you may notice that they deny separate payment for 20930-20938 when reported with arthrodesis or spinal instrumentation. If this happens to you, be sure to appeal the claim, noting that CPT specifically instructs, "Codes for obtaining autogenous bone ... grafts ... should be reported separately unless the code descriptor  references the harvesting of the graft or implant." Not only do the arthrodesis codes not reference the harvesting of bone grafts, a parenthetical reference preceding the arthrodesis codes states, "To report bone graft procedures, see codes 20930-20938."

Beware of these exceptions: If you report 20930 or 20936, however, don't expect to collect -- at least from Medicare payers. Medicare assigns no relative value units (RVUs) to 20930 or 20936 and considers them to be bundled services, according to the 2004 Physician Fee Schedule database. Therefore, Medicare payers will always bundle these codes into the more extensive procedure (for instance, the arthrodesis reported at the same time).

Leave -51 Off Spinal Bone Graft Codes CPT defines bone grafts as exempt from multiple- procedure rules, so you should not append modifier -51 (Multiple procedures) to 20930-20938. Accordingly, the February 1996 CPT Assistant states, "Codes 20930-20938, although appearing under the heading of General Musculoskeletal Procedures, apply only to bone grafts used for spine surgery ... These are specifically identified as add-on procedures. The -51 modifier is not used when these codes are reported with the definitive spine surgery code."

Because modifier -51 does not apply to these grafting codes, your payer should not cut your fee when you report [...]