Neurosurgery Coding Alert

Tip: Type of graft determines 22851 vs. 20931 If conflicting information on how to report allograft procedures is making you question when you should use code 22851, look no further. We-ll explain the cause of confusion and the correct way to report these procedures.

Neurosurgery Coding Alert experts advised in the December 2005 issue that you should report 22851 (Application of intervertebral biomechanical device[s] [e.g., synthetic cage(s), threaded bone dowel(s), methylmethacrylate] to vertebral defect or interspace) for a Cornerstone fibular allograft bone plug or bone spacer. But one of our subscribers, Ronda Tews, CPC, CCP, a compliance project manager for St. John's Health System in Springfield, Mo., says that physicians and coding consultants have told her not to use 22851 for the Cornerstone graft.

Solution: Neurosurgery Coding Alert went back to our sources to verify whether you can report 22851 with a -Cornerstone graft.- The answer is that you should use 20931 (Allograft for spine surgery only; structural) for the Cornerstone SR allograft series, and use 22851 only for the Verte-Stack Cornerstone spacers made of metal or PEEK. Threaded Bone Dowels Lead to 22851 To successfully choose the correct CPT procedure code when your neurosurgeon places an allograft, you-ll need to look closely at the op report. The type of graft your physician used will lead you to the code you should submit.

You have three code choices when your neurosurgeon places an allograft:

- 20930--Allograft for spine surgery only; morselized
- 20931--... structural
- 22851--Application of intervertebral biomechanical device(s) (e.g., synthetic cage[s], threaded bone dowel[s], methylmethacrylate) to vertebral defect or interspace. Your neurosurgeon may use several types of structural allografts, and the words he uses in his documentation will help you decide which code is appropriate. The different terms you may see are VG2 bone graft, interbody spacer, Cornerstone graft, mechanical spacer, Brantigan cages, VG2 allograft, Pyramesh cage, Pyramid ovoid mesh, PEEK cages, allograft interbody spinal implants, Osteotech interbody spacer, VG2 lordotic spacer, Medtronic Verte-Stack Cornerstone, Harms cage and titanium mesh vertebral body replacement, Tews says.

The procedures in which the neurosurgeon places the allograft versus the metal or PEEK spacer are not very different, says Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University department of surgery in New York.

In the February 2005 CPT Assistant, the American Medical Association clarified that the only allograft that qualifies for code 22851 is threaded-bone dowels. -All other bone allografts are structural allografts and should be reported with CPT code 20931,- the article explains. You should use code 20930 for any morselized allografts.

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