Wiki 20936????? laminectomy

[linc11]

Help! I have a surgeon who insists on coding a 20936 (autograft) when he mixes together beta tricalcium phosphate (allograft), with bone marrow aspirated from the patient. Has anybody else ever heard of this? I believe this should be coded as a straight allograft 20930 and bone marrow aspirate 38220. Any opinions? This is for a revision lumbar laminectomy.

 

[amanda23]

I would absolutely code 20930 (allograft) with 38220 (aspiration) in place of 20936 (autograft). This is what we do at our practice and insurance companies are paying for it when it is reported this way. (Unlike the 20936 which very rarely gets paid and almost always gets kicked back/denied.) Aspiration really is not autograft so it shouldn't be reported with 20936. And by reporting it this way you are not accounting for the allograft, which means your missing out on $$$$.
38220 with 20930 really is the best way to report this combo.
Check your RVU's and denial history. I would say that alone should be all the convincing your doc needs to start reporting this combo more accurately. Good Luck!

 

[linc11]

Amanda,

Thanks for the advice and I totally agree with you, this should not be billed as an autograft. I have also had the same experience regarding reimbursement with 20936 vs 20930 and think that is an excellent point. Thanks again for your input!
Lisa

 

[dfrender]

fusion

Would you post the aspiration the same way with a foot fusion for non-union?

 

[cbutler]

I agree with Amanda23... Code 20930 with 38220. This is what the doctors do at our practice and the payors reimburse for both codes.