Neurosurgery Coding Alert

Answer: Demineralized bone matrix, such as Osteofil or Grafton, is a commonly used bone graft substitute for spinal fusion, says Rhonda Petruziello, CPC, reimbursement specialist for neurosurgery at Cleveland Clinic Foundation in Cleveland. It is generally used in cases when an autogenous bone graft is unavailable.

The use of demineralized bone as a graft enhancer is important in multilevel spinal fusions, making it possible to harvest less autogenous bone and thereby decreasing the risks of donor site morbidity. Grafton can be added to either autogenous or allograft bone. Although CPT 2000 does not specifically include language that addresses the use of demineralized bone, there are codes in place that adequately describe various graft harvesting methods.

Code 20930 (allograft for spine surgery only; morselized) is used when the surgeon uses cadaver bone to fashion and insert a bone graft. This code can be used only when Grafton enhances the graft. When autogenous bone is harvested in addition to allograft material, report 20937 (autograft for spine surgery only [includes harvesting the graft]; morselized [through separate skin or facial incision]) or 20938 (autograft for spine surgery only [includes harvesting the graft]; structural, bicortical, or tricortical [through separate skin or fascial incision]) in addition to 20930.

In regard to harvesting of bone growth stimulation factor from the patients blood, the code reported would depend on the method used for obtaining the material. If the physician performs a needle aspiration of bone marrow, report 85095 (bone marrow; aspiration only). If another method is used and the procedure has not yet been assigned a CPT code, an unlisted code may be used with appropriate documentation to explain the procedure, or the neurosurgeon may attempt to analog the code.

To analog a code, find a coded procedure similar to the new procedure that does not yet have a code. Draw parallels between the coded procedure and the new uncoded procedure. If there is an area that requires a greater or lesser amount of time or skill, try to include specific estimates. For example, This new procedure generally takes 20 percent longer for the neurosurgeon to complete, therefore 20 percent should be added to the work relative value units, Petruziello says. List possible complications during the surgery that may differentiate the new uncoded procedure from the established coded procedure. Analoging codes can be an imperfect process. The key is to make an approximation of the new procedure being performed to the presenting problem, to the approach, to the anatomy, and to the end results.