Dbx bone graft

hbair99

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When a cpt code, for example 21147 lefort 1, 3pc, states with bone graft, does dbx or dbm (demineralized bone matrix) constitute with bone graft. I bill for the professional/surgeon in this scenerio. I think that the dbx/dbm is a product that the facility will bill for (hcpcs) but does not constitute application/harvesting of bone graft. I have looked for information regarding this and haven't found anything concrete. Any thoughts, thanks!!!!
 

Set_Apart

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I'm not an expert when it comes to the Lefort procedures however after reviewing the CPT lay description for 21147 it states that "cranial or iliac bone grafts are placed and the donor site repaired". I'm thinking that if your provider is only using demineralized bone matrix then this would not be billable as a bone graft as stated in the description. Again, I'm not an expert so hopefully someone else will chime in and give another opinion.

The physician performs a LeFort I osteotomy and bone grafts to repair congenital malformations or acquired deformities of the facial bones. With the patient under anesthesia, the physician makes a horizontal cut through the maxillary sinuses and nasal septum through an intraoral incision and into the pterygoid fissure. Surgical instruments are used to complete the separation of the maxilla from the skull base. The maxilla is down-fractured to mobilize it for movement into the proper predetermined position. If segmental surgery in the maxilla was necessary, the mobilized segments are held in position by a template secured to the upper teeth. Maxillary malpositioning is corrected. Cranial or iliac bone grafts are placed and the donor site repaired. The maxilla is wired to the mandible, which is positioned as a whole unit. Rigid fixation of the maxilla is achieved with miniplates or intermaxillary wires. The operative site is irrigated with antibiotic solution and the oral mucosa is closed as needed. Report 21145 if a single piece segment is repositioned; 21146 for lower maxillary midface reconstruction with two piece segmental movement; and 21147 if multiple piece (three or more) segmental osteotomies are performed.
 
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