Orthopedic Coding Alert

Question: Which codes should I use for a TKA with structural bone grafting of the lateral tibia plateau? I-m not sure I can report the graft separately because the surgeon didn't take the graft from a separate site.

Pennsylvania Subscriber

Answer: If the surgeon harvested the bone graft via a separate skin or fascial incision, you may report the appropriate bone graft code (20900-20902, Bone graft, any donor area -) in addition to the total knee arthroplasty (TKA), which you should report using 27447 (Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing [total knee arthroplasty]).

Rule: CPT guidelines state that you may code obtaining autogenous bone or other tissue separately if the surgeon gets the graft through a separate skin or fascial incision.

Exception: If the surgical code descriptor references harvesting the graft or implant, you shouldn't report obtaining the graft separately, the guidelines state.

Example of when not to code: The surgeon performs a Weaver-Dunn procedure using a graft from a hamstring, and you report 23552 (Open treatment of acromioclavicular dislocation, acute or chronic; with fascial graft [includes obtaining graft). You do not report a separate graft code in this case because the descriptor states "includes obtaining graft."