Wiki Reamer Irrigator Aspirator coding

[apomon]

I have a physician performing autograft bone harvest to left femur via reamer irrigator aspirator. this is more involved than cpt 20902. does anyone have any knowledge of coding these type of cases. I appreciate your feedback. thank you

op report:

 

[jovibon110@gmail.com]

I also looking for an answer to this question.

 

[christinnagle]

same here... Still haven't found any solid guidance. It's more complex than 20900 but a smaller bone graft harvested than 20902. So could go either way & use a modifier or should an unlisted code be used? See @apomon description for RAI.

The limited payment or increased push back from carriers on unlisted codes is making my appeal f/u report ridiculously long w/ these major carriers!!! So any additional coding guidance would be welcomed on RAI.

 

[amyjph]

It can depend on the CPT being reported for the surgery. If the repair is of a nonunion of the distal femur (27472) or tibia (27724) for example, obtaining the graft is included.
It's almost like 20225 but not a biopsy of course. I think you would still have to use 20902. In the example above they do an arthrotomy on the RT knee to gain access so you could almost report a knee arthrotomy, the problem is there's no other reason for it other than obtained access to get the graft. A 22 modifier may be an idea depending on the documentation.
I don't have CPT Assistant right now, but you can also check there to see if there is any guidance. Another option if your providers have access to AAOS is to ask the coding and reimbursement dept. https://www.aaos.org/ Another source could be getting advice from Zupko. https://karenzupko.com/

It looks like that case above is final stage of an infected open femoral fracture with nonunion/malunion where they put an abx spacer/nail temporarily to clear the infection. Maybe even segmental? But, depending on the code reported, if it's repair nonunion, etc. the graft is included so again, a 22 may be in order depending.