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The following article is written by Stephanie Ellis, RN, CPC, president of Ellis Medical Consulting.
It is important to know what type of graft is used in spine procedures (structural or morselized), as well as whether the bone grafts are allografts or autografts to choose the correct CPT code for billing.
A structural graft is a bigger piece of bone. A morselized graft involves cancellous bone or small bone fragments.
An allograft is a purchased graft harvested from a cadaver, whereas an autograft is bone harvested from the patient's own body.
A localized autograft is reusing the bone which was removed from the disc space during the discectomy procedure (CPT 20936), whereas, using bone harvested from another area where a separate incision is made (CPT 20937 — such as using the iliac crest).
Only one bone graft code from this section can be billed per case. If both allografts and autografts are used, it is best practice to bill an autograft code from the graft section, as the allografts are already being billed with code L8699 for purchased implants. Use code 20930 for a morselized allograft that is purchased or code 20931 for a structural allograft that is purchased.
Bill the implant with code L8699 or other valid code for the purchased implant for allografts.
CPT 20936 is for a morcellized autograft used in spine procedures which are obtained "through the same incision," such as from disc material removed during a discectomy. If a morcellized autograft is obtained through a separate incision, such as the iliac bone crest, use CPT 20937 and 38220-59.
Learn more about Ellis Medical Consulting.
The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
Related Articles on Spine Coding:
Surgery Center Coding Guidance: Posterior/Posterolateral Fusions
Surgery Center Coding Guidance: PLIF and TLIF Procedures
Surgery Center Coding Guidance: Anterior Cervical Diskectomy and Fusion Procedures