Allogenic Bone Graft CPT needed

ahalle

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I need some help, my doctor is asking for me to add a code for the bone graft on this arthrodesis, and my question is, is there a allogenic bone graft code for this? I looked at 20900 but it sounds like it is for a autograft harvesting which wasn't done. I already have the bone marrow code so that part is covered but can't figure out what code to add or if this would be inclusive of the arthrodesis. I'm still pretty new to Podiatry so could really use your advise.

Here is what I coded so far:
28750-LT Dx- M20.22, M96.0, M05.9 Arthrodesis,*great toe;*metatarsophalangeal*joint
20680-LT Dx- T84.84XA, T84.213A Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)
38232 Dx- M20.22, M96.0, M05.9, T84.84XA, T84.213A Bone marrow*harvesting for*transplantation;*autologous 1


Operation findings when his follow; patient was brought into the operating room and after
sedation intubation on the gurney the patient then was placed on operating table in normal
supine position. left thigh tourniquet was placed which was well-padded the left lower extremity
then was prepped and draped in normal sterile fashion.
Attention was made to the anterior medial proximal tibia where a 1 em incision was made this
incision was deepened with blunt dissection down to the anterior medial cortex of the proximal
tibia before we entered the lightning bone marrow aspiration needle under power intramedullary.
We aspirated 60 cc of bone marrow aspirate concentrate this was handed off to the back table
where it would be center fused to 5 cc concentration. This wound then was irrigated closed with
a 4-0 nylon Xeroform 2 x 2 and a Tegaderm
left lower extremity then was exsanguinated and elevated tourniquet was inflated to 275 mmHg
pressure. Attention was made to the dorsal medial aspect of left first metatarsal phalangeal joint
where there is noted to be prior surgery this old incision was used as our new incision just medial
to the extensor hallucis longus tendon. This incision was straight down to bone with significant
amount of scar tissue all soft tissue reflected off of the first metatarsal head and the base of the
proximal phalanx. There was noted to be a proud screw backing out in the plantar medial aspect
of the first metatarsal head 3 oh headless compression screw that was tenting the skin all soft
tissues were released off of this and this was pulled out in toto will be sent to pathology. There
was a dorsal plate 4 hole that was broken right at the joint 2 screws proximal to screws distally
these were removed along with the broken plate and will be sent the pathology. There was no
signs of any infection or corrosion of any of the implants. There is noted to be nonunion fibrous
of the first MPJ. This time the joint then was prepared for revision arthrodesis by removing any
scar tissue fibrosis within the joint subchondral drilling of the subchondral plate of the first
metatarsal head and the base the proximal phalanx wound was copiously irrigated we then took a
5 mm first metatarsal head wedge allogenic graft from Paragon soaked in bone marrow for over
3 minutes and then put that in our joint for a distraction arthrodesis with good anatomical fit At
this time the first MPJ was placed in a proximally 5 degrees of dorsiflexion and about 5 degrees of
abduction we held this with 2 crossing wires we then using good AO techniques placed a large
first metatarsal phalangeal joint plate from Paragon using 6 3.5 fully threaded screws that were
locking we reviewed this multiple times intraoperatively under fluoroscopy using AP and lateral
making sure R's platelet was well adhered to the bone with good alignment in all of our screws
were a good length. Once our plate and screws were satisfactory along with our alignment we
removed all temporary wires we then made the bone graft with demineralized bone matrix
approximately 2 cc and bone marrow aspiration 3 cc mixed with 1 cc of amnion right at our
arthrodesis site. Following this we then closed the wound using 3-0 Vicryl for the deep capsule
was then injected the other 2 cc of bone marrow aspiration concentrate and underneath the
capsule and then closed the skin with a 3-0 nylon postoperative injections included 10 cc of half
percent Marcaine plain. This is followed by overnight ointment Adaptic 4 x 4 fluffs Kerlix and an
Ace bandage. Tourniquet was dropped there is good perfusion all digits hemostasis was
controlled.
 

Orthocoderpgu

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No code for the bone graft

There is no code for the bone graft. That's just part of the procedure.

You also can't bill 20680. You will need to go to CMS.GOV and pull up the CMS NCCI Surgery Policy Manual for orthopedics. If internal hardware needs to be removed in order to perform a procedure, it's not reported separately.
 

ahalle

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There is no code for the bone graft. That's just part of the procedure.

You also can't bill 20680. You will need to go to CMS.GOV and pull up the CMS NCCI Surgery Policy Manual for orthopedics. If internal hardware needs to be removed in order to perform a procedure, it's not reported separately.
Thank you so much, that was my initial thought on this but I started questioning myself and thinking I was missing something. I will look for that surgery policy as well, I didn't quite think that part thru on this one, I know your right I just have figure out how to convince the doctor now.
 

Orthocoderpgu

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Local Chapter Officer
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If you need help, let me know

I have the surgical policy manual in PDF and can email that to you if need be, but it is at CMS.GOV in the ncci edits section.
 
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