Grafts/Implants
Question:
I know in years past from attending KZA/ AAOS workshops that the instructors taught that bone grafts (CPT code 20900 and 20902) were only reportable if the graft was harvested via a separate incision. Our surgeon recently did an arthroplasty procedure and harvested local bone to fill in bone voids. The surgeon wanted to code separately and I told the surgeon about needing to have made a separate incision. Now, I am questioning myself and wondering if this is still correct?
Answer:
Yes, you are correct. CPT continues to provide guidelines for Grafts/Implants that may be found in the 2022 CPT Manual Professional Edition on page 147.
The instructions address reporting services when obtaining autogenous bone, cartilage, fascia lata, bone marrow or other tissues. The instructions state a separate CPT code should be reported when the graft/implant is harvested via separate skin/fascial incisions. An exception applies when the CPT code descriptor references the harvest of a graft as included in the code.
This section of CPT applies to CPT codes 20900, 20902, 20910, 20912, 20920, 20922, and 20924.
CPT codes 20900 and 20902 are described as:
20900: Bone graft, any donor area; minor or small (eg, dowel or button)
20902: Bone graft, any donor area; major or large
An exception applies when the CPT code descriptor references the harvest of a graft as included in the code.
Two examples of CPT codes where the descriptor states “includes obtaining graft” follow:
25274: Repair, tendon or muscle, extensor, forearm and/or wrist; secondary, with free graft (includes obtaining graft), each tendon or muscle
25431: Repair of nonunion of carpal bone (excluding carpal scaphoid (navicular)) (includes obtaining graft and necessary fixation), each bone
The harvest of the graft (tendon (20924) or bone (20900, 20902)) is inclusive regardless of whether obtained via the same or separate incision. A tendon graft or bone graft code is not separately reportable with these two primary codes.
Different rules apply to the other CPT codes 20930-20939, 20932-20934 that are also found in this section of CPT.
