Bone biopsy question

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How does one determine if a bone is considered superficial or deep?

I'm trying to figure out the correct code for a bone biopsy of the sacrum performed during a procedure to excise the coccyx and a sacral pressure ulcer.

I was thinking it was code 20240 but I'm being told I'm wrong, but close.

Thanks
 

sofily

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Bone Biopsy

You are correct in choosing CPT code 20240 for the Sacrum biopsy. This code covers biopsy's on the "spinous process" which includes the sacrum and coccyx.

Definiation of the code below is taken from Ingenix' Encoderpro.com:

The physician performs an open biopsy on bone to confirm a suspected growth, disease, or infection. With the patient under general anesthesia, and placed in the appropriate position, the physician makes an incision overlying the biopsy site and carries it down through the tissue to the level of the bone being biopsied. A piece of bone tissue is removed and sent for examination. The wound is sutured closed and the patient is moved to the recovery area. Report 20240 if the biopsy is of a superficial bone such as the ribs, ilium, sternum, or spinous process; this code is for an open biopsy.

Use CPT 20220 for trocar or needle biopsy:
The physician usually performs a biopsy on bone to confirm a suspected growth, disease, or infection. The physician normally uses local anesthesia; however, general anesthesia may be used. The physician places a large needle into the spinous process or other superficial bone to obtain the sample in 20220.
 
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I believe the surgeon would be debriding the ulcer down to bone and taking a biopsy of sacrum. If that is the case, it should not be coded separately. If this is a separate procedure meaning the intent was to do biopsy, then it should be coded as 20245, as it is not superficial bone. Superficial means in close proximity of skin and not under muscle.
 
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