How To Use CPT Code 20225

CPT code 20225 describes the procedure for a bone biopsy using a trocar or needle in deep tissue, such as the vertebral body or femur. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 20225?

CPT 20225 is used to describe the procedure for a bone biopsy using a trocar or needle in deep tissue, specifically in areas such as the vertebral body or femur. This code is used when a healthcare provider extracts samples of bone tissue for laboratory analysis to determine the presence of bone disease.

2. Official Description

The official description of CPT code 20225 is: ‘Biopsy, bone, trocar, or needle deep (eg, vertebral body, femur).’ It is important to note that CPT code 20225 should not be reported in conjunction with codes 22510, 22511, 22512, 22513, 22514, 22515, 0200T, or 0201T when performed at the same level. Additionally, for bone marrow biopsy and/or aspiration, different codes should be used (38220, 38221, 38222). For radiologic supervision and interpretation, refer to codes 77002, 77012, and 77021.

3. Procedure

The procedure for CPT code 20225 involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The healthcare provider examines the area to be biopsied.
3. A small stab incision is made in the skin over the targeted area.
4. A large diameter biopsy needle or trocar is inserted through the stab incision and advanced into the bone.
5. The correct position of the biopsy tool is confirmed.
6. A sample of tissue is extracted using the biopsy tool.
7. The extracted tissue sample is submitted for laboratory examination.
8. The incision is closed.

4. Qualifying circumstances

CPT code 20225 is used for bone biopsies in deep tissue, such as the vertebral body or femur. It should not be used for bone marrow biopsies, which have separate codes. The procedure is typically performed when there is a suspicion of bone disease and the healthcare provider needs to obtain a tissue sample for further analysis.

5. When to use CPT code 20225

CPT code 20225 should be used when a bone biopsy is performed using a trocar or needle in deep tissue, specifically in areas such as the vertebral body or femur. It is important to note that this code should not be used for bone marrow biopsies or superficial bone biopsies, as there are separate codes for those procedures.

6. Documentation requirements

To support a claim for CPT code 20225, the healthcare provider must document the following information:

• Patient’s diagnosis or suspicion of bone disease
• Specific location of the biopsy (e.g., vertebral body, femur)
• Date of the procedure
• Details of the procedure, including the use of a trocar or needle
• Confirmation of correct positioning of the biopsy tool
• Description of the tissue sample extracted
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 20225, ensure that the procedure meets the criteria for a bone biopsy using a trocar or needle in deep tissue. It is important to note that this code should not be reported in conjunction with certain other codes, as specified in the official description. Additionally, for bone marrow biopsies or radiologic supervision and interpretation, different codes should be used.

8. Historical information

CPT code 20225 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Similar codes to CPT 20225

There are several similar codes to CPT code 20225, including:

• CPT 20220: This code is used for superficial bone biopsies.
• CPT 38220: This code is used for bone marrow biopsy, needle or trocar.
• CPT 38221: This code is used for bone marrow biopsy, needle or trocar, aspiration only.
• CPT 38222: This code is used for bone marrow biopsy, needle or trocar, biopsy and aspiration.
• CPT 77002: This code is used for radiologic supervision and interpretation of bone biopsies.

9. Examples

1. A healthcare provider performs a bone biopsy using a trocar in the vertebral body to investigate a suspected spinal tumor.
2. A patient undergoes a bone biopsy using a needle in the femur to determine the cause of unexplained bone pain.
3. A healthcare provider uses a trocar to perform a bone biopsy in the femur to assess for the presence of metastatic cancer.
4. A bone biopsy is performed using a needle in the vertebral body to investigate a suspected infection in the spine.
5. A patient undergoes a bone biopsy using a trocar in the femur to evaluate a suspected bone fracture that is not healing properly.
6. A healthcare provider performs a bone biopsy using a needle in the vertebral body to assess for the presence of osteoporosis.
7. A bone biopsy is performed using a trocar in the femur to investigate a suspected bone infection.
8. A patient undergoes a bone biopsy using a needle in the vertebral body to determine the cause of unexplained back pain.
9. A healthcare provider uses a trocar to perform a bone biopsy in the femur to assess for the presence of bone cancer.
10. A bone biopsy is performed using a needle in the vertebral body to investigate a suspected spinal fracture.