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You cannot separately bill for allografts...

  1. Smile You cannot separately bill for allografts...
    Medical Coding Books
    A physician wants to bill CPT 29888 along with CPT 20926 for ACL reconstruction with allograft.

    It is my understanding:
    1) you cannot report the allograft separately because all allografts, except those used in spine surgery, are included in the surgical package

    2) the graft codes in the CPT book are for obtaining autografts (the implantation of any graft is included in the surgical package for the procedure requiring the graft)

    3) allografts are pre-harvested so there is no surgical work on this physician's part in obtaining the allograft so you cannot charge CPT 20926 for "obtaining" it.

    Am I completely wrong? partially wrong? or totally right?

    YOUR COMMENTS (YES USE CPT 20926 - or - NO DON'T USE CPT 20926) WILL BE GREATLY APPRECIATED. Please provide references when possible.

    Thanks, and have a great day!
    Deb

  2. Default
    Deb,
    Go to AAOS.org and type in 29888 in the search box. The 1st thing that pops up is the April 2005 AAOS Bulletin and it specifically refers to the allo/autograft and whether it's bundled or not. Good luck with your Doc!
    Jenna

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    20926 is a code for tissue graft, this is for making a separate incision to harvest fat and /or fascia to graft in a different area.

    Debra A. Mitchell, MSPH, CPC-H

  4. Default
    Quote Originally Posted by JMeggett View Post
    Deb,
    Go to AAOS.org and type in 29888 in the search box. The 1st thing that pops up is the April 2005 AAOS Bulletin and it specifically refers to the allo/autograft and whether it's bundled or not. Good luck with your Doc!
    Jenna
    Thank you so much - that did it!

    I had searched AAOS for "allograft" and was only finding the one article
    from the March 2008 "AAOS NOW".

    The April 2005 article really spells it out the way I wanted to convey it.

  5. Default
    Quote Originally Posted by mitchellde View Post
    20926 is a code for tissue graft, this is for making a separate incision to harvest fat and /or fascia to graft in a different area.
    Thanks for the feedback - I really appreciate it!

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