Wiki CPT codes 20930 allograft VS 22853 Zimmer Allograft.

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carol52

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Hello , we are having a discussion on the allografts. I was told years ago not to use the 22853 to use instead the 20930 We
are getting denials back saying that the 20930 is not being covered.
Would someone please explain this to me....
Thanks,
Carol
 
20930 is the usual code for an allograft done as part of a spinal surgery. 22853 is something different - that's for placement of a mechanical device, not an allograft.

Without more information it's hard to say why you'd be getting denials for 20930 - that could happen for any number of reasons. A non-covered denial usually has something to do with payer policy or plan benefits, not coding. Have you spoken to the payer to get more information about why it's being denied?
 
I sent a reply email but will respond here. the interbody device has to be filled with a graft. either Allo, Auto, or both. You would code 22853 with and/or 20936,20930. If Surgeon is Structuring or creating the interbody device with allograft you would only bill 20931 in place of 22853/20936/20930. Hope this helps. I have not seen any payers pay for 20930. We have to adjust them.
 
jrclark1987@yahoo.com said:
I sent a reply email but will respond here. the interbody device has to be filled with a graft. either Allo, Auto, or both. You would code 22853 with and/or 20936,20930. If Surgeon is Structuring or creating the interbody device with allograft you would only bill 20931 in place of 22853/20936/20930. Hope this helps. I have not seen any payers pay for 20930. We have to adjust them.
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I didn't receive an email, but I agree with what you're saying here regarding the coding - I just wasn't sure why you said you were told not to use 22853 and to use 20930 instead.

Are you billing for the facility or the physician? If facility, an add-on code usually won't have a separate line-item payment on a facility claim.

If it's a physician claim, what are the primary procedure codes you're billing this with that you're see a denial, and what denial reason codes are you getting? Have you inquired with any of the payers as to why they're not paying?
 
thomas7331 said:
I didn't receive an email, but I agree with what you're saying here regarding the coding - I just wasn't sure why you said you were told not to use 22853 and to use 20930 instead.

Are you billing for the facility or the physician? If facility, an add-on code usually won't have a separate line-item payment on a facility claim.

If it's a physician claim, what are the primary procedure codes you're billing this with that you're see a denial, and what denial reason codes are you getting? Have you inquired with any of the payers as to why they're not paying?
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SORRY FOR THE CONFUSION. I was replying to Carol. I was never told to replace 22853 with 20930. I am in KY and payers deny due to inclusive to the Procedure. which is understandable. you cannot complete an arthrodesis without some type of graft material. thanks
 
jrclark1987@yahoo.com said:
SORRY FOR THE CONFUSION. I was replying to Carol. I was never told to replace 22853 with 20930. I am in KY and payers deny due to inclusive to the Procedure. which is understandable. you cannot complete an arthrodesis without some type of graft material. thanks
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Oops, sorry, that was my mistake, I thought I was replying to the original poster!
 
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