Orthopedic Coding Alert

Question: My spine surgeon performed an anterior interbody fusion, posterior scoliosis correction, and posterior fusion during the same operative session. For both fusions he used morselized allograft. He wants to code the graft twice. Can we report 20930 once for the anterior fusion, and then a second time with modifier 59 for the posterior fusion?


North Carolina Subscriber

Answer: You can only report one unit of 20930 (Allograft for spine surgery only; morselized) per operative session, so you should not bill multiple units of the code to your payer.

In addition, most insurers will not reimburse you for 20930. Although the National Correct Coding Initiative does not bundle 20930 into certain spine surgery codes, Medicare designates graft procedure 20930 as a status -B- code. CMS policy dictates that Medicare payers always bundle this code into payment for other services.

In other words, Medicare does not preclude you from reporting, but it will not pay you extra for the grafting procedures.

In fact, because of the code's status -B- designation, Medicare payers will never pay you for these services, regardless of the primary procedure code(s) you claim. In addition, you cannot charge the patient for the disallowed amounts because Medicare has -already paid- you for these services as part of the payment for the primary procedure.

Private payers may reimburse 20930, so don't stop reporting the code. Your best strategy with Medicare is simply to write off the code as -disallowed- when Medicare does not pay.