Advanced Search

Orthopedic Coding Alert

Reader Question:

Billing for a Medicare Patient

Published on Tue Jan 01, 2002

Question: Should 20936 and 20937 be billed together with modifier -59? This is a Medicare patient. I dont think it is payable, but the surgeon is insisting that I bill for it.

Missouri Subscriber  
Answer: It appears that your surgeon did two separate grafts from two separate sites during the same operative session, since 20936 (autograft for spine surgery only [includes harvesting the graft]; local [e.g., ribs, spinous process, or laminar fragments] obtained from same incision) differs from 20937 (autograft for spine surgery only [includes harvesting the graft]; morselized [through separate skin or fascial incision]) only in respect to the donor site. The problem here is that 20936 has a status code of B (bundled) on the Medicare fee schedule and is not eligible for separate reimbursement, even with modifier -59 (distinct procedural service) appended. If you need written documentation to offer your physician, contact your area Medicare carrier representative for assistance.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Orthopedic Coding Alert

View All