Wiki Autograft and Allograft with spinal fusion

[CodeAudit71]

I need advice on the appropriate coding for the following scenario:

A decompressive laminectomy was done L5-S1 using a high-speed drill and various Kerrison
punches. Thecal sac and nerve roots were well decompressed. At this point, I entered the disk space at L5-S1. It was very degenerated and small. I was able to open it and then clean it out using various scrapers from the wave set. Two wave expandable cages packed with the patient's own bone mixed with Progenix were carefully introduced in the space.

22630
63047,59
22851
20936

My co-worker thinks I should add 20930 for the Progenix that is mixed with the patient's bone. Advice or any regulatory guidance references appreciated!

 

[nyyankees]

I need advice on the appropriate coding for the following scenario:

A decompressive laminectomy was done L5-S1 using a high-speed drill and various Kerrison
punches. Thecal sac and nerve roots were well decompressed. At this point, I entered the disk space at L5-S1. It was very degenerated and small. I was able to open it and then clean it out using various scrapers from the wave set. Two wave expandable cages packed with the patient's own bone mixed with Progenix were carefully introduced in the space.

22630
63047,59
22851
20936

My co-worker thinks I should add 20930 for the Progenix that is mixed with the patient's bone. Advice or any regulatory guidance references appreciated!

you could but I believe only Cigna or Aetna will pay for allograft. Other carriers will not pay.

 

[LLynn29]

Agreed. Bill 22851 for the cage but not 20930 or 20936. I don't know of any carriers that will pay these codes.

 

[mhstrauss]

Can you run a report from your practice management system to see if there are any trends? Might want to check that before deciding to stop billing completely. We are still getting paid by BCBS of LA, commercial Humana, Cigna, Medicaid, and several other smaller payers, for the graft codes, mainly just not Medicare and the MA plans, and any UHC. Would be worth looking into if you have access.