Wiki rib graft 21235

[freespririt0806]

i have a question about billing a rib graft to repair valve collapse, it the doctor does not actually harvest it, here is my doctors response

I've not been able to find a code for homologous donor rib so I've always used the code there that includes harvesting. I am not harvesting but am certainly carving and prepping the graft which takes work and time. It is not a synthetic alloplast so I don't think any implant codes are appropriate.

is this billable as 21235?

thank you

 

[b.cobuzzi]

You cannot use 21235 because that is for harvesting and placing cartilage graft and your doctor is carving and prepping a rib graft.

21230 has lay description and clinical responsibility from Codify as follows:

The provider applies autogenous cartilage graft, taken from the patient’s own rib, to the face, including the chin, nose, or ear, to repair deformity due to fracture, injury, tumor resection, or congenital defect, such as saddle nose deformity

Clinical Responsibility
When the patient is appropriately prepped and anesthetized, the provider makes an incision over the rib area at a site chosen for harvesting the cartilage graft. He removes sufficient autograft material and closes the wound. To repair a saddle nose deformity, he carves the rib graft into two pieces, a dorsal graft and a columellar strut, which are interdigitated, or interlocked, to recreate an intact L shaped strut, which provides the normal shape of the nose. Once the graft is in the correct position, the provider sutures the dome of the nose over the graft with a transdomal suture, or suture over the nasal tip, closing the wound.
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It does not address using the rib for nasal valve problems, but I assume that your surgeon's application is appropriate. The part I have underlined in the Clinical Responsibility is what your surgeon is doing, only for the upper nasal valve, not for a saddle nose deformity. I would think that coding 21230-52 would be appropriate and then in Box 19 indicate that the rib did not have to be harvested but it was shaped and contoured and placed in the nose to repair the upper nasal valve.