Wiki Oral maxillofacial surgery cpt question

[hbair99]

I am new to this type of surgery and need a quick clarification. Two codes on an older surgery that our billers are working on use 20912 and 20926. These are codes for harvesting the bone grafts are they not???? They are not for the application of the bone graft????? Would love to hear from anyone and if you have any ideas on some great places to check for further info for oral maxillofacial surgery questions I would love those leads too!!!

 

[CHROMEa8]

Grafts (or Implants)

Codes for obtaining autogenous (obtained from one's own body, self-generated) bone, cartilage, tendon, fascia lata grafts, or other tissues through separate skin/fascial incisions should be reported separately unless the code descriptor references the harvesting of the graft or implant (e.g. includes obtaining graft) CPT 2017 DO NOT append modifier 62 to bone grafts 20900-20938.

You are correct -these are NOT for the application (the graft is lifted and implanted in the recipient
site in a separately reportable procedure. The donor site is sutured in layers).

 

[hbair99]

More CPT help

Thank you for the response about the harvesting versus the application. I was so sure, but it looks like the coders here have used it incorrectly for so long and no one has questioned. If anyone has a moment please look at the other two codes and see if you agree. 14060 and 41870. I believe these two are correct.

Once the patient was identified in the preoperative
waiting area, he was brought back to the OR, where he was smoothly induced
by the anesthesia team and then turned over to the OMFS team, who safely
and usually prepped the patient in the sterile fashion for an oral surgical
procedure. After a timeout was performed, attention was first drawn to the
left lip commissure region where a 45-degree Z-plasty was performed using a
#15 blade. The areas were undermined with a 15 blade and a tenotomy, and a
small Burow triangle was removed from the lip region. The area was closed
with Vicryl sutures deep and nylon sutures on the skin. Attention was then
drawn to the left ala, where a 15 blade was used to make an alar incision
at the alar-philtral groove. This area was lifted to expose the fat but
not entering into the nasal cavity. The fat was then debulked, and a
pocket was created up to the tip defining points of the nasal tip. At this
point, the allogeneic rib cartilage was shaped and fit to this region.
This was secured with a 4-0 nylon suture. A Weir-style incision was made
at the base of the left ala to help shape and move the nasal ala laterally.
Prior to finishing suturing fixation, patency was determined to be widened
and better than initial presentation. Nasal speculum evaluated the inside
of the nose and noted there were no tears. The skin was then closed with
Vicryl sutures deep and nylon sutures on the skin. Attention was then
drawn to the intraoral resection over tooth #11 where the gingival
recession was released with a 12B blade and a half-thickness mucoperiosteal
flap was elevated. This was connected into a Z-plasty incision over a scar
band. The Z-plasty was secured, and a full-thickness palatal graft of the
left maxilla was taken and sutured after deepithelializing the lateral
portions underneath the Z-plasty portion of the mucosal flaps. This was
secured with 5-0 chromic gut sutures. The entire area was copiously
irrigated and closed. Hemostasis was controlled. Cold pack was placed on
the left maxilla. Bacitracin was placed on the incision lines, and the
patient was turned over to the anesthesia team, who ex