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Thread: Billing for Allograft

  1. #1
    Join Date
    Apr 2007

    Default Billing for Allograft

    AAPC: Back to School
    Is it legit to bill for 2 allografts in one surgery? The surgeon did an anterior and a posterior fusion. We billed for 20930 and 20931. The insurance paid for one and denied the other stating a graft can only be billed once per date of service. I need to appeal and thought that this would be legit as it was done anterior and posterior-two separate incisions. If yes, what supporting documentation can I send besides the op note.

    Thanks in advance for any help,
    Judith L. Doss, CPC
    OAD Orthopaedics

  2. #2
    Join Date
    Apr 2007


    Did you put a modifier on the 2nd code?

  3. #3
    Join Date
    Apr 2007

    Default Billing for Allografts

    No, should I have a 59 modifier on it?

  4. #4
    Join Date
    Apr 2007
    Leesburg, VA


    According to a Webinar my department just listened to, you can only bill a specific graft once per session (i.e.- you can't bill 20930 twice), however, you can bill 20930-20937 individually during the same session (so you can bill 20930 and 20931 together).

    In your situation, though, it's different- because it was two different approaches, it's two different sessions, so you can bill 20930 twice if necessary.

    Mbort was correct, though, you'll want to add a -59 modifier for it, especially because if thephysician did a posterior and anterior approach, they're completely different sessions (they have to flip the patient, re-drape, re-scrub, etc...), so the -59 modifier can be used to specify that you're working not only in two different locations, but also in two different sessions.

    Hope that helps some...
    Catherine J. Steburg, CPC, CEMC
    Leesburg, VA Chapter President

  5. #5
    Join Date
    Apr 2007

    Default Billing for Allografts

    Yes, that helps. Thanks, to you both!


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