Neurosurgery Coding Alert

Graft type matters more than number

On occasion, such as during a complicated, multi-level fusion/arthrodesis, the surgeon may place bone grafts in more than one location, using the same or different types of grafts (allograft vs. autograft, structural vs. morselized).

Most payers will not reimburse you for additional grafts of the same type at more than one location. You would only report one unit of the appropriate graft code, regardless of the number of grafts of that type the surgeon placed, says Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University department of surgery.

The American Medical Association supports this coding. According to the January 2004 CPT Assistant, -Each type of bone graft code for spinal surgery (20930-20938) may be reported one time for a spinal procedure, regardless of the number of vertebral levels being surgically fused (i.e., not once per spinal interspace or segment fused).-

Some payers, however, may reimburse you for different types of grafts at more than one location. The national Correct Coding Initiative does not bundle grafting codes into one another, and CPT does not prohibit reporting more than one type of spinal graft (when necessary and supported by documented medical necessity). And the 2003 North American Spine Society (NASS) publication Common Coding Scenarios for Comprehensive Spine Care advises coders to list more than one bone graft code, when performed, for spine procedures.

Bottom line: Unless your payer specifies otherwise, report each type of graft that your surgeon performs.

Example: During extensive arthrodesis, the surgeon uses a morselized allograft at C3-C4 and a morselized local autograft at C4-C5. You should report:

- 20936 for the autograft
- 20930 for the allograft
- an appropriate arthrodesis code(s) to describe the fusion procedure (for example, 22554, cervical arthrodesis at the initial level, and 22585 for each additional level)
- any instrumentation the surgeon placed, using an appropriate code. Alternative scenario: If the surgeon used morselized allograft at both C3-C4 and C4-C5, you would only report a single unit of 20930 because you may not report multiple units of the same bone graft code.

A point to keep in mind: Although proper coding dictates that you should report 20930 and/or 20936 when performed, payers may not reimburse separately for these procedures.