How To Use CPT Code 20245

CPT code 20245 describes an open deep bone biopsy procedure, which involves obtaining a sample of bone tissue from a specific area, such as the humeral shaft, ischium, or femoral shaft. 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 20245?

CPT code 20245 is used to describe an open deep bone biopsy procedure. This procedure involves the removal of a sample of bone tissue from a specific area, such as the humeral shaft, ischium, or femoral shaft. The purpose of the biopsy is to further analyze a suspected medical condition or infection.

2. Official Description

The official description of CPT code 20245 is: ‘Biopsy, bone, open deep (eg, humeral shaft, ischium, femoral shaft)’

3. Procedure

The open deep bone biopsy procedure involves the following steps:

1. The healthcare provider examines the area of the bone that needs to be biopsied.
2. A small percutaneous incision is made over the targeted area of the humeral shaft, ischium, or femoral shaft.
3. The provider performs sharp dissection through the fascia and muscle to approach the targeted bone.
4. Once the bony process is identified, a rongeur or bone shaver is used to access the deep bone cavity.
5. The provider debrides the deep internal layer of bone and excises it as a biopsy specimen.
6. After obtaining a satisfactory bone sample, the incision is sutured in a layered fashion.

4. Qualifying circumstances

CPT code 20245 is used when a healthcare provider performs an open deep bone biopsy procedure. This procedure is typically performed when there is a suspected medical condition or infection that requires further analysis. The specific areas of the humeral shaft, ischium, or femoral shaft may be targeted for biopsy.

5. When to use CPT code 20245

CPT code 20245 should be used when a healthcare provider performs an open deep bone biopsy procedure. This code is appropriate when the provider removes a sample of bone tissue from the humeral shaft, ischium, or femoral shaft. It is important to note that this code should not be used for other types of bone biopsies, such as excisional or incisional biopsies.

6. Documentation requirements

To support a claim for CPT code 20245, the healthcare provider must document the following information:

• The reason for the biopsy and the suspected medical condition or infection
• The specific area of the bone targeted for biopsy (humeral shaft, ischium, or femoral shaft)
• The date of the procedure
• A detailed description of the procedure, including the incision site and the instruments used
• The size and nature of the bone tissue sample obtained
• The closure method used for the incision

7. Billing guidelines

When billing for CPT code 20245, it is important to ensure that the procedure performed meets the criteria for an open deep bone biopsy. The documentation should clearly indicate the specific area of the bone targeted for biopsy. It is also important to note that CPT code 20245 should not be reported with other codes for excisional or incisional bone biopsies.

8. Historical information

CPT code 20245 was added to the Current Procedural Terminology system on January 1, 1990. There have been some historical changes to the code, including code changes in 2004 and 2017.

9. Similar codes to CPT 20245

There are several similar codes to CPT code 20245, including:

• CPT 20246: Biopsy, bone, open, superficial (eg, ilium, sternum, spinous process, ribs)
• CPT 20247: Biopsy, bone, trocar, or needle; deep (eg, vertebral body, femur)
• CPT 20248: Biopsy, bone, trocar, or needle; superficial (eg, ilium, sternum, spinous process, ribs)
• CPT 20250: Biopsy, muscle; superficial
• CPT 20251: Biopsy, muscle; deep

9. Examples

1. A healthcare provider performs an open deep bone biopsy on a patient’s humeral shaft to further analyze a suspected bone tumor.
2. A patient undergoes an open deep bone biopsy on their ischium to investigate a suspected bone infection.
3. A healthcare provider performs an open deep bone biopsy on a patient’s femoral shaft to determine the cause of unexplained bone pain.
4. A patient undergoes an open deep bone biopsy on their humeral shaft to investigate a suspected bone fracture that is not healing properly.
5. A healthcare provider performs an open deep bone biopsy on a patient’s ischium to further analyze a suspected bone metastasis.
6. A patient undergoes an open deep bone biopsy on their femoral shaft to investigate a suspected bone cyst.
7. A healthcare provider performs an open deep bone biopsy on a patient’s humeral shaft to determine the cause of unexplained bone swelling.
8. A patient undergoes an open deep bone biopsy on their ischium to investigate a suspected bone tumor.
9. A healthcare provider performs an open deep bone biopsy on a patient’s femoral shaft to further analyze a suspected bone infection.
10. A patient undergoes an open deep bone biopsy on their humeral shaft to investigate a suspected bone fracture that is not healing properly.