Modifier for tendon autograft

AgnieszkaMarek

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The CPT Manual states that CPT code 20924, indicates a tendon graft obtained "from a distance." You cannot bill this code separately from CPT code 29888 (ACL repair where a tendon graft is obtained from a separate incision on the same knee, which is the standard in these types of procedures). This does not constitute a far enough distance to bill for it separately, according to the CPT Assistant.

The tendon graft procedure is only billable when the graft is obtained from the ankle area on the same leg, from the opposite knee, or from another distant area.

I do understand that code 29888 incudes graft, yet despite I put modifier or not for harvesting tendon I am still getting audit that these codes cannot be submit together ( I use 3M for coding). Any idea what to do?

Aga
 

thomas7331

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The NCCI bundling edit for these codes was added on October 1, 2016 - effective with that date of service, for payers that use NCCI, these two codes can't be billed together even with a modifier. I haven't seen any official publication as to why this particular change was made, but it's usually because CMS decides that the value assigned to the primary code now covers the costs of the bundled code and will no longer pay it separately.
 

CodingKing

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NCCI lists it as 0 meaning no modifier will bypass edit which is why you are having issues
 
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