How To Use CPT Code 20900

CPT 20900 describes a bone graft procedure that restores structural integrity and natural osseous tissue to a bony defect. 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 20900?

CPT 20900 is a code used to describe a bone graft procedure. This procedure involves replacing missing bones with material from the patient’s own body or from an artificial, synthetic, or natural substitute. The provider typically obtains the bone graft from the iliac crest, ribs, or fibula, with the fibula being the preferred site due to its versatility, shape, size, and strength.

2. Official Description

The official description of CPT code 20900 is: ‘Bone graft, any donor area minor or small (e.g., dowel or button).’ This code encompasses the surgical procedure of replacing missing bones with material from the patient’s own body or from a substitute.

3. Procedure

During a bone graft procedure (CPT 20900), the provider follows a specific set of steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision over the donor site, such as the iliac crest or fibula.
3. The incision is extended to the level of fascia and muscle.
4. A surgical retractor is used to pull back soft tissue, fascia, and muscles, exposing part of the bone.
5. The provider extracts a button or dowel-shaped circular bone segment using a bone shaver.
6. The wound at the donor site is closed by suturing in a layered fashion.

4. Qualifying circumstances

CPT 20900 is performed when there is a bony defect that requires restoration of structural integrity. The procedure is suitable for patients who need bone grafting, whether it is to replace missing bones or to repair damaged bones. The provider may harvest the graft from the patient’s own body or use a substitute material. The specific circumstances and patient eligibility should be determined by the provider based on the individual case.

5. When to use CPT code 20900

CPT code 20900 should be used when a bone graft procedure is performed to restore missing or damaged bones. It is important to ensure that the procedure meets the criteria outlined in the code description. If the procedure involves obtaining autogenous grafts through separate incisions, separate codes should be reported unless the code descriptor explicitly includes obtaining the graft. It is crucial to accurately document the details of the procedure to support the use of CPT code 20900.

6. Documentation requirements

When reporting CPT code 20900, the provider must document the following information:

• Patient’s diagnosis or indication for the bone graft procedure
• Specific details of the procedure, including the donor area and the type of graft used
• Date of the procedure
• Any additional procedures or services performed in conjunction with the bone graft
• Any complications or unexpected findings during the procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 20900, it is important to ensure that the procedure meets the criteria outlined in the code description. The provider should use the appropriate code based on the specific circumstances of the bone graft procedure. Modifier 62, which indicates two surgeons, should not be appended to bone graft codes in the Musculoskeletal System section. It is essential to review the specific billing guidelines and requirements of the payer to ensure accurate and appropriate reimbursement.

8. Historical information

CPT code 20900 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 20900

There are several similar codes to CPT 20900 within the range of General Grafts (or Implants) Procedures on the Musculoskeletal System (20900-20939). These codes include procedures for bone grafts of varying sizes and complexities. It is important to review the code descriptions and select the most appropriate code based on the specific procedure performed.

9. Examples

1. A patient undergoes a bone graft procedure using a dowel-shaped bone segment harvested from their own fibula to repair a bony defect in their tibia.
2. A provider performs a bone graft procedure using a button-shaped bone segment obtained from the patient’s iliac crest to replace a missing bone in their mandible.
3. A bone graft procedure is performed using a synthetic substitute material to restore structural integrity to a bony defect in the patient’s radius.
4. A patient undergoes a bone graft procedure using a dowel-shaped bone segment harvested from their own rib to repair a bony defect in their sternum.
5. A provider performs a bone graft procedure using a button-shaped bone segment obtained from the patient’s fibula to replace a missing bone in their ulna.
6. A bone graft procedure is performed using an artificial substitute material to restore structural integrity to a bony defect in the patient’s femur.
7. A patient undergoes a bone graft procedure using a dowel-shaped bone segment harvested from their own iliac crest to repair a bony defect in their scapula.
8. A provider performs a bone graft procedure using a button-shaped bone segment obtained from the patient’s fibula to replace a missing bone in their clavicle.
9. A bone graft procedure is performed using a synthetic substitute material to restore structural integrity to a bony defect in the patient’s humerus.
10. A patient undergoes a bone graft procedure using a dowel-shaped bone segment harvested from their own rib to repair a bony defect in their pelvis.