Wiki You cannot separately bill for allografts... - bill CPT 29888

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Deb Jones - CPC

Deb Jones - CPC

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A physician wants to bill CPT 29888 along with CPT 20926 for ACL reconstruction with allograft.

It is my understanding:
1) you cannot report the allograft separately because all allografts, except those used in spine surgery, are included in the surgical package

2) the graft codes in the CPT book are for obtaining autografts (the implantation of any graft is included in the surgical package for the procedure requiring the graft)

3) allografts are pre-harvested so there is no surgical work on this physician's part in obtaining the allograft so you cannot charge CPT 20926 for "obtaining" it.

Am I completely wrong? partially wrong? or totally right?

YOUR COMMENTS (YES USE CPT 20926 - or - NO DON'T USE CPT 20926) WILL BE GREATLY APPRECIATED. Please provide references when possible.

Thanks, and have a great day!
Deb
 
Lay description

NO, you do not use 20926 for allografts. The lay description for this code is:

The physician obtains a paratenon, fat, or dermis graft. The physician incises the skin and retracts the skin flap to expose the underlying connective tissue. The tissue is incised to the required layer. The graft is lifted and implanted in the recipient site in a separately reportable procedure. The donor site is sutured in layers. (emphasis added by FTB)

Going to the shelf to get the allograft material does not qualify as obtaing a graft.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
Agree with the above...CMS does touch on this code in the NCCI edits...

3. If a tissue transfer procedure such as a graft (e.g., CPT codes 20900-20926) is included in the code descriptor of a primary procedure, the tissue transfer procedure is not separately reportable.
4. CPT code 20926 describes a graft of “other” tissues such as paratenon, fat, or dermis. Similar to other graft codes, this code may not be reported with another code where the code descriptor includes procurement of the graft. Additionally, CPT code 20926 may be reported only if another graft HCPCS/CPT code does not more precisely describe the nature of the graft.
 
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