Results 1 to 5 of 5

You cannot separately bill for allografts... - bill CPT 29888

  1. Arrow You cannot separately bill for allografts... - bill CPT 29888
    Exam Training Packages
    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!

  2. #2
    No don't use cpt 20926
    Mary, CPC, CANPC, COSC

  3. #3
    Milwaukee WI
    Default Lay description
    NO, you do not use 20926 for allografts. The lay description for this code is:

    The physician obtains a paratenon, fat, or dermis graft. The physician incises the skin and retracts the skin flap to expose the underlying connective tissue. The tissue is incised to the required layer. The graft is lifted and implanted in the recipient site in a separately reportable procedure. The donor site is sutured in layers. (emphasis added by FTB)

    Going to the shelf to get the allograft material does not qualify as obtaing a graft.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #4
    North Carolina
    Agree with the above...CMS does touch on this code in the NCCI edits...

    3. If a tissue transfer procedure such as a graft (e.g., CPT codes 20900-20926) is included in the code descriptor of a primary procedure, the tissue transfer procedure is not separately reportable.
    4. CPT code 20926 describes a graft of “other” tissues such as paratenon, fat, or dermis. Similar to other graft codes, this code may not be reported with another code where the code descriptor includes procurement of the graft. Additionally, CPT code 20926 may be reported only if another graft HCPCS/CPT code does not more precisely describe the nature of the graft.

  5. Default
    Thank you so much Mary, F Tessa & Rebecca - I greatly appreciate the input!

Similar Threads

  1. frozen strut allografts to femur
    By klbecker in forum Orthopaedics
    Replies: 0
    Last Post: 01-14-2014, 03:21 PM
  2. You cannot separately bill for allografts...
    By Deb Jones - CPC in forum Medical Coding General Discussion
    Replies: 4
    Last Post: 09-03-2009, 04:29 PM
  3. BMP Allografts
    By jfahan in forum Orthopaedics
    Replies: 4
    Last Post: 04-23-2009, 03:14 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.