Orthopedic Coding Alert

NCCI doesn't bundle these bone graft codes into the spinal fusion codes

Although CPT and the National Correct Coding Initiative (NCCI) bundle bone grafting into some surgical procedures, you can safely report 20930-20938 with most spinal arthrodesis and instrumentation codes.
 
Orthopedic coders are accustomed to denials when they report grafting codes with surgical codes such as 23485 (Osteotomy, clavicle, with or without internal fixation; with bone graft for nonunion or malunion [includes obtaining graft and/or necessary fixation]). Because the descriptor clearly states, "includes obtaining graft," your insurer will immediately deny any grafting codes that you report in addition to the surgery.

You can, however, report bone graft harvesting in addition to most arthrodesis (22548-22812) and spinal instrumentation (22840-22855) procedures. CPT includes the following applicable grafting codes:

20930 -- Allograft for spine surgery only; morselized
20931 -- ... structural
20936 -- Autograft for spine surgery only (includes harvesting the graft; local (e.g., ribs, spinous process, or laminar fragments) obtained from same incision
20937 -- ... morselized (through separate skin or fascial incision)
20938 -- ... structural, bicortical or tricortical (through separate skin or fascial incision). Don't Append -51 to Spinal Bone Graft Codes According to the February 1996 CPT Assistant, "Codes 20930-20938, although appearing under the heading of General Musculoskeletal Procedures, apply only to bone grafts used for spine surgery ... These are specifically identified as add-on procedures. The -51 modifier is not used when these codes are reported with the definitive spine surgery code."

Because modifier -51 (Multiple procedures) does not apply to these grafting codes, your payer should not cut your fee when you report 20931, 20937 or 20938 with an arthrodesis code. But if you report 20930 or 20936, don't expect to collect. Medicare assigns no relative value units to these procedure codes and considers them "bundled" services, meaning that they will always be bundled into the more extensive procedure. Is the Graft From the Patient? Use Autograft Codes Surgeons obtain bone grafts from either an allograft or an autograft, and the codes differ depending on the material the physician uses.

If the orthopedist obtains the graft from the patient's own body (for example, he takes bone from the patient's rib to complete a spinal fusion), you should report an autograft code (20936-20938). Select 20936 if he obtains the graft from a bone he accesses through the same incision as the fusion, says Annette Grady, CPC, CPC-H, senior healthcare consultant at Eide Bailly LLP in Bismarck, N.D., and chair of the North American Spine Society's administrative task force. Choose 20937 or 20938 if the surgeon must create a separate skin or fascial incision at a different site to harvest the graft.

Surgeons do not personally harvest allografts, which explains why reimbursement is normally $60-80 less for [...]