Orthopedic Coding Alert

When performing arthrodesis procedures at multiple levels, your surgeon may use more than one graft. Generally, each type of bone graft may be reported one time regardless of the number of segments being fused.

Good idea: Confirm with your payer before reporting multiple grafts, since payers may have specific guidelines for these services.

Caveat: You do not report one graft per segment or level. "The bone grafts codes can be reported once per session for each type of bone graft used," says Jennifer Schmutz, CPC, health information coder at the Neurosurgical Associates, LLC in Salt Lake City, Utah. "There are six different CPT® codes available to use for bone grafting during spinal surgeries, which include the CPT® range +20930-+20938 and 38220 (Bone marrow; aspiration only)," says Schmutz. "The coder may assign a code for each type of bone graft used, however each CPT® may only be coded once per surgical session."

In an exceptional situation, your surgeon may use both an autograft and an allograft at different levels. In this case, you can report multiple bone graft codes.

"Another exception occurs when the same graft type is harvested from a completely separate body site. For example, in anterior and posterior surgery, you may report the harvest of a cancellous autograft (+20937) from an anterior iliac site and a posterior iliac site," Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison. "The -59 (Distinct procedural service:...) modifier should be applied to identify the separate surgical site. However, a payer may have a payment policy that will not recognize the additional physician work. In contrast, you would not report +20937 (cancellous iliac autograft) and +20938 (structural iliac autograft) from the same single surgical site." "When surgeons use a femoral ring allograft (FRA) for interbody fusion, they will often fill the center of the ring with morselized allograft; in this scenario, one would report codes +20931 for the FRA and +20930 for the morselized allograft," Heidi Stout, BA, CPC, COSC, PCS, CCS-P, Coder on Call, Inc., Milltown, New Jersey and orthopedic coding division director, The Coding Network, LLC, Beverly Hills, CA.