Orthopedic Coding Alert
Using 20900? Check for Separate Incision
Question: Which codes should I use for a TKA with structural bone grafting of the lateral tibia plateau? I’m not sure I can report the graft separately because the surgeon didn’t take the graft from a separate site.
Pennsylvania Subscriber
Answer: If the surgeon harvested the bone graft via a separate skin or fascial incision, you may report the appropriate bone graft code (20900-20902, Bone graft, any donor area …) in addition to the total knee arthroplasty (TKA), which you should report using 27447 (Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing [total knee arthroplasty]).
Rule: CPT® guidelines state that you may code obtaining autogenous bone or other tissue separately if the surgeon gets the graft through a separate skin or fascial incision.
Exception: If the surgical code descriptor references harvesting the graft or implant, you shouldn’t report obtaining the graft separately, the guidelines state. If this was for an allograft, you can’t add any additional code for it.
Example of when not to code: The surgeon performs a Weaver-Dunn procedure using a graft from a hamstring, and you report 23552 (Open treatment of acromioclavicular dislocation, acute or chronic; with fascial graft [includes obtaining graft). You do not report a separate graft code in this case because the descriptor states “includes obtaining graft.”
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