Neurosurgery Coding Alert

Not all spinal grafting codes will reimburse separately

Fail-proof spinal bone graft coding is as easy as learning some basic terminology and paying attention to where the surgeon obtains the material she grafts. If you can answer the following three questions, you can always choose a code with confidence. 1. Autograft or Allograft? If the surgeon harvests bone from the patient's own body to graft into the spine, you must choose an autograft (autos = -self-) code 20936, 20937 or 20938 (see -Spinal Bone Graft Codes- below for full code descriptors).

For example: The surgeon removes a portion of bone from the patient's rib, reshapes the bone as necessary, and grafts it into the spine for reconstruction.

In contrast, an allograft (20930 and 20931) comes from a human donor (either a living donor or a cadaver) for use in a different human recipient (allos = -other-).

The operating surgeon does not harvest the allograft (although he may shape the bone prior to placing it). Rather, the operating surgeon obtains the previously harvested, frozen or freeze-dried allograft from a surgical or regional bone bank prior to surgery, says Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University department of surgery.

If physician documentation mentions that the bone comes from a bone bank, an allograft code is appropriate. 2. If Autograft, Same or Different Incision? If documentation specifies an autograft, you must next determine if the surgeon harvested the bone from the same incision through which she places the graft, or if she must make a separate incision to harvest the bone.

If the surgeon harvests and places the bone via the same incision--by taking, for instance, bone tissue from the ribs, spinous process or laminar fragments--you may immediately select the -local- autograft code 20936, Sandhusen says.

If the surgeon harvests and removes the bone through a skin or fascial incision, then makes a second, separate incision to place the bone in the spine, you have one more question to answer before you can choose the proper code. 3. Structural or Morselized? For all allograft procedures, and for any autograft that the surgeon does not harvest and place via the same incision, you must determine if the graft is structural or morselized. A structural bone graft consists of a single piece of bone that provides direct support for skeletal structures.

A morselized (or small-segment) graft consists of several smaller pieces of bone packed together to fill bony cavities, primarily to promote new bone growth, Sandhusen says. For example, following posterior cervical laminectomy and instrumentation, the surgeon may place morselized bone in open areas on either side of the spine and in the facet joint spaces. The surgeon may obtain the morselized graft from a bone bank, [...]