How To Use CPT Code 20240

CPT code 20240 describes an open, superficial bone biopsy procedure that is used to obtain a sample of bone tissue for further analysis. 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 20240?

CPT code 20240 is used to describe an open, superficial bone biopsy procedure. This procedure involves obtaining a sample of bone tissue from areas such as the sternum, spinous process, rib, patella, olecranon process, calcaneus, tarsal, metatarsal, carpal, or phalanx. The purpose of the biopsy is to further analyze a suspected medical condition or infection.

2. Official Description

The official description of CPT code 20240 is: ‘Biopsy, bone, open superficial (eg, sternum, spinous process, rib, patella, olecranon process, calcaneus, tarsal, metatarsal, carpal, metacarpal, phalanx)’

3. Procedure

The open, superficial bone biopsy procedure involves several steps:

1. The patient is appropriately prepped and anesthetized.
2. The healthcare provider examines the area to be biopsied.
3. A small percutaneous incision is made in the targeted area using a scalpel.
4. The provider performs sharp dissection with a blade, going through the fascia and muscle to approach the targeted bone.
5. Once the bony process is identified, a rongeur or bone shaver is used to minimally debride the bone or bony process.
6. The debrided bone tissue is then removed as a biopsy sample.
7. After obtaining a satisfactory bone sample, the incision is closed by suturing it in a layered fashion.

4. Qualifying circumstances

CPT code 20240 is used when an open, superficial bone biopsy is performed on areas such as the sternum, spinous process, rib, patella, olecranon process, calcaneus, tarsal, metatarsal, carpal, or phalanx. The procedure is typically done to analyze a suspected medical condition or infection. It is important to note that this code specifically refers to open, superficial bone biopsies and not other types of bone biopsies.

5. When to use CPT code 20240

CPT code 20240 should be used when an open, superficial bone biopsy is performed on the specified areas. It is important to ensure that the biopsy is performed in a superficial manner and not deep within the bone. If the biopsy is performed on a different area or involves a different technique, a different CPT code may be more appropriate.

6. Documentation requirements

To support a claim for CPT code 20240, the healthcare provider must document the following information:

• Patient’s diagnosis or suspected condition
• Specific area of the bone biopsied
• Description of the procedure performed
• Details of the incision and closure
• Any complications or additional procedures performed
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 20240, it is important to ensure that the procedure meets the criteria for an open, superficial bone biopsy. The documentation should clearly indicate the specific area of the bone biopsied and the details of the procedure performed. It is also important to follow any specific billing guidelines provided by the payer or coding guidelines.

8. Historical information

CPT code 20240 was added to the Current Procedural Terminology system on January 1, 1990. There have been a few historical changes to the code, including updates to the description and inclusion of additional areas for biopsy.

9. Similar codes to CPT code 20240

There are several similar codes to CPT code 20240 that may be used for different types of bone biopsies. Some examples include:

• CPT 20245: Biopsy, bone, open deep (eg, ilium, ischium, pubis, femur)
• CPT 20250: Biopsy, bone, trocar, or needle; superficial (eg, ilium, sternum, spinous process, ribs, trochanter of femur)
• CPT 20251: Biopsy, bone, trocar, or needle; deep (eg, ilium, ischium, pubis, femur)

9. Examples

1. A patient undergoes an open, superficial bone biopsy on their sternum to further analyze a suspected infection.
2. A healthcare provider performs an open, superficial bone biopsy on a patient’s patella to investigate a suspected medical condition.
3. An individual undergoes an open, superficial bone biopsy on their calcaneus to determine the cause of persistent pain.
4. A patient undergoes an open, superficial bone biopsy on their metatarsal to investigate a suspected fracture.
5. A healthcare provider performs an open, superficial bone biopsy on a patient’s carpal bone to analyze a suspected tumor.
6. An individual undergoes an open, superficial bone biopsy on their phalanx to further investigate a suspected infection.
7. A patient undergoes an open, superficial bone biopsy on their spinous process to determine the cause of persistent back pain.
8. A healthcare provider performs an open, superficial bone biopsy on a patient’s rib to investigate a suspected fracture.
9. An individual undergoes an open, superficial bone biopsy on their olecranon process to analyze a suspected medical condition.
10. A patient undergoes an open, superficial bone biopsy on their tarsal bone to further investigate a suspected infection.