How To Use CPT Code 20936

CPT 20936 refers to the use of an autograft for spine surgery, which involves harvesting the graft from the patient’s own bone through the same incision. This article will cover topics such as the description, procedure, qualifying circumstances, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT code 20936.

1. What is CPT 20936?

CPT 20936 is a medical code used to describe a specific type of spinal surgery that involves the use of an autograft. An autograft is a type of donor bone that is harvested from the patient’s own body, typically from the same surgical incision. This code is used to report the harvesting and use of the autograft during a spinal surgery procedure.

2. 20936 CPT code description

The official description of CPT code 20936 is: “Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure)”.

3. Procedure

The 20936 procedure involves the following steps:

1. The patient is prepped and anesthetized for spinal surgery.
2. The surgeon makes an incision at the appropriate location on the patient’s spine.
3. The autograft is harvested from the patient’s own bone, typically from the same incision site.
4. The harvested autograft is used to fill in bony defects during the spinal surgery procedure.
5. The incision is closed, and the patient is monitored during recovery.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 20936 services are those who require spinal surgery and would benefit from the use of an autograft. This may include patients with spinal deformities, degenerative disc disease, spinal fractures, or other conditions that require spinal fusion or stabilization. The decision to use an autograft and report CPT code 20936 is typically made by the surgeon based on the patient’s specific needs and the surgeon’s clinical judgment.

5. When to use CPT code 20936

It is appropriate to bill the 20936 CPT code when a spinal surgery procedure involves the use of an autograft harvested from the patient’s own bone through the same incision. This code should be used in conjunction with the primary procedure code for the spinal surgery being performed. It is important to note that CPT code 20936 is an add-on code and should not be billed as a standalone service.

6. Documentation requirements

To support a claim for CPT 20936, the following information should be documented in the patient’s medical record:

• A detailed description of the spinal surgery procedure, including the use of the autograft.
• The specific location from which the autograft was harvested (e.g., ribs, spinous process, or laminar fragments).
• Confirmation that the autograft was obtained from the same incision as the primary spinal surgery procedure.
• Any relevant preoperative and postoperative diagnoses and clinical findings.
• Operative notes and any relevant imaging studies or laboratory results.

7. Billing guidelines

When billing for CPT code 20936, it is important to follow the appropriate guidelines and rules. This code is an add-on code and should be reported in addition to the primary spinal procedure code. Modifier 50 (Bilateral procedure) should not be appended to 20936, as the concept of bilateral surgery does not apply to spinal grafting. Additionally, be aware that some payers, including Medicare, may not provide separate reimbursement for this code, as it may be bundled into the payment for the primary procedure.

8. Historical information

CPT 20936 was added to the Current Procedural Terminology system on January 1, 1996. The code was later changed on January 1, 2008, with the previous descriptor being “Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision”.

9. Similar codes to CPT 20936

Five similar codes to CPT 20936 include:

1. CPT 20930: This code refers to the use of an allograft, which is a donor bone from another individual, for spine surgery.
2. CPT 20931: This code describes the use of an allograft with a structural component for spine surgery.
3. CPT 20937: This code involves the use of an autograft harvested from a separate incision for spine surgery.
4. CPT 20938: This code refers to the use of an autograft with a structural component harvested from a separate incision for spine surgery.
5. CPT 22558: This code describes an anterior interbody fusion procedure for the lumbar spine, which may involve the use of an autograft or allograft.

10. Examples

Here are 10 detailed examples of CPT code 20936 procedures:

1. A patient with degenerative disc disease undergoes a lumbar spinal fusion using an autograft harvested from the patient’s own spinous process through the same incision.
2. A patient with scoliosis undergoes a posterior spinal fusion using an autograft harvested from the patient’s own ribs through the same incision.
3. A patient with a spinal fracture undergoes a spinal stabilization procedure using an autograft harvested from the patient’s own laminar fragments through the same incision.
4. A patient with spondylolisthesis undergoes a lumbar spinal fusion using an autograft harvested from the patient’s own spinous process through the same incision.
5. A patient with spinal stenosis undergoes a cervical spinal fusion using an autograft harvested from the patient’s own ribs through the same incision.
6. A patient with a herniated disc undergoes a lumbar discectomy and fusion using an autograft harvested from the patient’s own spinous process through the same incision.
7. A patient with a spinal tumor undergoes a spinal decompression and fusion using an autograft harvested from the patient’s own laminar fragments through the same incision.
8. A patient with kyphosis undergoes a thoracic spinal fusion using an autograft harvested from the patient’s own ribs through the same incision.
9. A patient with a spinal infection undergoes a spinal debridement and fusion using an autograft harvested from the patient’s own spinous process through the same incision.
10. A patient with a spinal deformity undergoes a corrective spinal surgery using an autograft harvested from the patient’s own laminar fragments through the same incision.