How To Use CPT Code 20931

CPT 20931 refers to the use of a structural allograft during spine surgery. This article will cover the code description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 20931 procedures.

1. What is CPT 20931?

CPT 20931 is a code used to describe the application of a structural allograft during a spinal surgery procedure. A structural allograft is a type of donor bone used to fill in bony defects during the surgery. This code is an add-on code and must be reported with an allowable primary spinal procedure code.

2. 20931 CPT code description

The official description of CPT code 20931 is: “Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure)”.

3. Procedure

The 20931 procedure involves the following steps:

  1. The patient is appropriately prepped and anesthetized for a spinal surgery procedure.
  2. The provider identifies the bony defects that need to be filled during the surgical procedure.
  3. The provider selects the appropriate size and shape of the structural allograft material.
  4. The structural allograft is applied to the bony defects during the spinal surgery procedure.
  5. The provider completes the remainder of the spinal surgery procedure.

4. Qualifying circumstances

Patients eligible to receive CPT code 20931 services are those undergoing a spinal surgery procedure that requires the use of a structural allograft to fill in bony defects. The structural allograft must be obtained from a human donor who is a different person from the recipient. The code can only be used in conjunction with allowable primary spinal procedure codes.

5. When to use CPT code 20931

It is appropriate to bill the 20931 CPT code when a provider uses a structural allograft during a spinal surgery procedure to fill in bony defects. The code should be used as an add-on code and reported with an allowable primary spinal procedure code.

6. Documentation requirements

To support a claim for CPT 20931, the following information needs to be documented:

  • The patient’s medical history and the necessity for the spinal surgery procedure.
  • A detailed description of the bony defects that required the use of a structural allograft.
  • The size and shape of the structural allograft material used during the procedure.
  • A step-by-step account of the procedure, including the application of the structural allograft.
  • The primary spinal procedure code used in conjunction with CPT 20931.

7. Billing guidelines

When billing for CPT code 20931, keep in mind the following guidelines:

  • Report 20931 as an add-on code with an allowable primary spinal procedure code.
  • Do not append modifier 50 (Bilateral procedure) to 20931, as the concept of bilateral surgery with spinal grafting does not apply.
  • If the procedure is performed bilaterally, report the add-on code twice.

8. Historical information

CPT 20931 was added to the Current Procedural Terminology system on January 1, 1996. The code has undergone the following changes:

  • Code Changed on 01-01-2008: Allograft for spine surgery only; structural
  • Code Changed on 01-01-2011: Allograft for spine surgery only; structural (List separately in addition to code for primary procedure)

9. Similar codes to CPT 20931

Five similar codes to CPT 20931 and how they differentiate are:

  1. CPT 20930: This code refers to the use of a morselized allograft or placement of osteopromotive material during spine surgery, rather than a structural allograft.
  2. CPT 22532: This code describes an anterior interbody fusion procedure in the lumbar spine, which may or may not involve the use of an allograft.
  3. CPT 22548: This code refers to an anterior cervical discectomy and fusion procedure, which may involve the use of an allograft but is focused on the cervical spine.
  4. CPT 22612: This code describes a posterior lumbar interbody fusion procedure, which may involve the use of an allograft but is focused on the lumbar spine.
  5. CPT 22800: This code refers to a spinal fusion procedure for deformity correction, which may involve the use of an allograft but is focused on correcting spinal deformities.

10. Examples

Here are 10 detailed examples of CPT code 20931 procedures:

  1. A patient with degenerative disc disease undergoes a lumbar spinal fusion procedure, and the provider uses a structural allograft to fill in bony defects.
  2. A patient with a spinal deformity undergoes a corrective spinal fusion procedure, and the provider uses a structural allograft to provide additional support and stability.
  3. A patient with a herniated disc undergoes an anterior cervical discectomy and fusion procedure, and the provider uses a structural allograft to fill in the space left by the removed disc.
  4. A patient with spinal stenosis undergoes a posterior lumbar interbody fusion procedure, and the provider uses a structural allograft to fill in bony defects and promote fusion.
  5. A patient with spondylolisthesis undergoes a spinal fusion procedure, and the provider uses a structural allograft to fill in bony defects and stabilize the spine.
  6. A patient with a spinal fracture undergoes a spinal fusion procedure, and the provider uses a structural allograft to fill in bony defects and promote healing.
  7. A patient with a spinal tumor undergoes a spinal fusion procedure following tumor removal, and the provider uses a structural allograft to fill in bony defects and provide support.
  8. A patient with a spinal infection undergoes a spinal fusion procedure following debridement, and the provider uses a structural allograft to fill in bony defects and promote healing.
  9. A patient with a degenerative scoliosis undergoes a spinal fusion procedure, and the provider uses a structural allograft to fill in bony defects and correct the spinal curvature.
  10. A patient with a spinal instability undergoes a spinal fusion procedure, and the provider uses a structural allograft to fill in bony defects and provide additional support to the spine.

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