Orthopedic Coding Alert

Question: Our surgeon used both demineralized bone matrix putty (DBX) and bone marrow from the patient's tibia to repair her femoral fracture non-union. I wanted to report 27472, but the surgeon wants to report 27470 and 38220 to demonstrate that he used autograft marrow, not just bone. Who is correct?

Washington, D.C., Subscriber

Answer: The surgeon is correct. Experts consider DBX "allograft," so you cannot separately report it. The physician does not perform any extra work to harvest the graft material (because DBX does not come from the patient's own body), so you should report 27470 (Repair, nonunion or malunion, femur, distal to head and neck; without graft [e.g., compression technique]) for the nonunion repair with allograft. Because 27472 (... with iliac or other autogenous bone graft [includes obtaining graft]) includes graft harvesting, you should not report it for this procedure.

Physicians use aspiration to harvest bone marrow, so you should report 38220 (Bone marrow; aspiration only) in addition to 27470.

-- You Be the Coder and Reader Questions were reviewed by Heidi Stout, CPC, CCS-P, coding and reimbursement manager at University Orthopaedic Associates in New Brunswick, N.J.