Surgery Center Coding Guidance: Grafts Used in Spine Surgery
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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 ), whereas, using bone harvested from another area where a separate incision is made (CPT — 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 L for purchased implants. Use code for a morselized allograft that is purchased or code for a structural allograft that is purchased.
Bill the implant with code L or other valid code for the purchased implant for allografts.
CPT 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 and
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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
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Tell me about coding for Autograft.
CPT code reads "Autograft for spine surgery only [includes harvesting the graft]; local [eg. ribs, spinous process, or laminar fragments] obtained from the same incision". The SRS agrees that local bone harvested from the spinal incision and within the area already being dissected to prepare for fusion is incidental to the posterior fusion codes CPT This would include bone fragments from the posterior elements of the spine: laminar fragments, spinous processes and facets and perhaps rib heads or small fragments of the ribs obtained from the spinal dissection as it extends to the tip of the transverse processes. Surgeons would all agree that harvesting of ribs is an entirely different and independent procedure that falls under the code of , " Autograft for spine surgery only: morselized through separate skin or fascial incision". Although the major spine incision may be used, another fascial incision is required and surgeons often use another parallel longitudinal incision centered over the rib hump. Even if the rib harvesting is through the main spinal incision, it requires a separate fascial incision, considerable dissection out laterally over the ribs, and a lengthy procedure to subperiosteally expose multiple ribs and remove them from the chest. It requires significant time and expertise, but certainly may be the surgeon's choice for the appropriate source of autologous graft material in order to obtain adequate amounts of autograft, to correct the rib hump deformity, and to allow further correction of the spinal deformity. (HH Steel, "Rib Resecton and Spine Fusion in Correction of Convex Deformity in Scoliosis" JBJS(A), Sept, 65(7) pp: DC Mann, CL Nash Jr., MR Wilham, RH Brown, "Evaluation of the Role of Concave Rib Osteotomies in the Correction of Thoracic Scoliosis", Spine , May, 14(5) pp) When rib autograft is being harvested to serve as the primary graft material, that is another situation entirely than using local available bone. As above, harvesting of multiple lengthy segments of ribs includes not only extensive additional dissection and surgical knowledge and skill but also significant time in then preparing the rib segments into strips appropriate for graft material. This is not an incidental procedure to the main posterior arthrodesis codes It is an additional procedure taking significant time, additional risk, additional blood loss and requires specialized knowledge and skill on the surgeon's part. It is done to obtain autograft by those surgeons who wish to use the patient's own bone and as an alternative to harvesting the iliac crest for autograft. Clearly CPT code would be the appropriate code in this case, not CPT
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