Orthopedic Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: My surgeon insists that I code 20936 and 20937 with modifier -59 for a Medicare patient. Is this correct? Missouri Subscriber Answer: The subscriber's question suggests that the surgeon performed two grafts from two sites during the same operative session because 20936 (Autograft for spine surgery only [includes harvesting the graft]; local [e.g., ribs, spinous process, or laminar fragments] obtained from same incision) differs from 20937 ( morselized [through separate skin or fascial incision]) with respect to donor site only. The problem here is that 20936 has a status code of B (bundled) on the Medicare fee schedule and is not eligible for separate reimbursement, even with modifier -59 (Distinct procedural service) appended. If you need written documentation to offer your physician, contact your area Medicare carrier representative for assistance.