Orthopedic Coding Alert

Have trouble choosing between 22851 and 20931?  We've got the answer

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

The challenge: Although some coders believe 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, other coding consultants believe that you should not report 22851 for the Cornerstone graft. Which advice is accurate?

The facts: You should use 20931 (Allograft for spine surgery only; structural) for the Cornerstone SR allograft series, says Judy Larson, CPC, coder at Rockford Orthopedic Associates LTD in Rockford, Ill.

You should report 22851 if your surgeon applies a prosthetic device, such as 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 orthopedic surgeon places an allograft, you-ll need to look closely at the op report. The type of graft your physician uses will lead you to the code you should submit.

You have three code choices when your orthopedic surgeon 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.

Code 20931 keyword alert: Your surgeon 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.

The procedures in which the surgeon places the allograft rather than 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 22851 is the threaded bone dowel. -All other bone allografts are structural allografts and should be reported with CPT code 20931,- the article says. You should use 20930 for any morselized allografts.

Note: You should also report 22851 when the surgeon places a cage, the ovoid mesh, or the titanium mesh.

Example: A patient with C5-C6 degenerative cervical disk disease (722.4, Degeneration of cervical intervertebral disk) presents to your practice. The surgeon performs anterior interbody fusion at that level with minimal diskectomy (without decompression) and places [...]