Billing for Allograft

judithdoss

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Oakbrook
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Is it legit to bill for 2 allografts in one surgery? The surgeon did an anterior and a posterior fusion. We billed for 20930 and 20931. The insurance paid for one and denied the other stating a graft can only be billed once per date of service. I need to appeal and thought that this would be legit as it was done anterior and posterior-two separate incisions. If yes, what supporting documentation can I send besides the op note.

Thanks in advance for any help,
Judith L. Doss, CPC
OAD Orthopaedics
 

ceejay413

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Highland Springs, VA
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According to a Webinar my department just listened to, you can only bill a specific graft once per session (i.e.- you can't bill 20930 twice), however, you can bill 20930-20937 individually during the same session (so you can bill 20930 and 20931 together).

In your situation, though, it's different- because it was two different approaches, it's two different sessions, so you can bill 20930 twice if necessary.

Mbort was correct, though, you'll want to add a -59 modifier for it, especially because if thephysician did a posterior and anterior approach, they're completely different sessions (they have to flip the patient, re-drape, re-scrub, etc...), so the -59 modifier can be used to specify that you're working not only in two different locations, but also in two different sessions.

Hope that helps some...
 
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