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Question: An orthopedic surgeon performed an open reduction and internal fixation (ORIF) of a right navicular stress fracture with an iliac crest bone marrow aspirate. The op note states the provider aspirated 5 cc of bone marrow from the inner table (iliac crest), concentrated the aspirate, and then placed it into channels drilled into the navicular bone.

The surgeon initially assigned 20900, but I don’t think that code is accurate, and I think I should use 20999.

Can you help me select the correct code for the bone marrow aspiration?

AAPC Forum Subscriber

Answer: Based on the information you’ve provided, 20900 (Bone graft, any donor area; minor or small (eg, dowel or button)) is an incorrect code choice. You’ll use this code when the physician obtains cortical bone, and bone marrow isn’t the same as cortical bone. At the same time, you won’t assign an unlisted code like 20999 (Unlisted procedure, musculoskeletal system, general) since the CPT^® code set includes a code that accurately reflects the procedure performed.

Instead, you’ll assign Category III code 0232T (Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed) to report the bone marrow aspirate concentration (BMAC) procedure you describe. While the descriptor mentions platelet-rich plasma (PRP), you will still assign 0232T when the bone marrow is harvested, concentrated, and reinjected, like with PRP procedures.

Plus, when you search the CPT^® Index for Stem Cells > Bone Marrow Aspiration, you’ll find 0232T as a code option, which you can verify in the code set.

Mike Shaughnessy, BA, CPC, Production Editor, AAPC