How To Use CPT Code 20902

CPT code 20902 describes the procedure for bone grafting, specifically for major or large bone defects. 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 20902?

CPT 20902 is a code used to describe the procedure for bone grafting. It specifically refers to the restoration of structural integrity and natural osseous tissue to a site with a major or large bone defect. The provider obtains a bone graft from a donor area, such as the iliac crest, ribs, or preferably the fibula, due to its versatility, shape, size, and strength. This procedure aims to increase the strength of the bony defect, ensuring its longevity over time.

2. Official Description

The official description of CPT code 20902 is: ‘Bone graft, any donor area major or large.’

3. Procedure

1. The patient is appropriately prepped and anesthetized for the procedure.
2. The provider makes an incision over the donor site, extending it to the level of fascia and muscle.
3. A surgical retractor is used to pull back soft tissue, fascia, and muscles, exposing part of the bone.
4. The provider uses a bone shaver to extract a large circular bone segment, larger than the shape and size of a button graft.
5. This larger bone graft is then used to fill major and larger bone defects.
6. The wound at the donor site is closed by suturing in a layered fashion.

4. Qualifying circumstances

CPT 20902 is used when there is a major or large bone defect that requires a bone graft. The provider may obtain the graft from any donor area, such as the iliac crest, ribs, or fibula. The procedure is typically performed by a surgeon or other qualified healthcare professional with expertise in bone grafting techniques.

5. When to use CPT code 20902

CPT code 20902 should be used when performing a bone graft procedure to address major or large bone defects. It is important to ensure that the specific circumstances of the patient’s condition meet the criteria for this code. If the bone defect is not major or large, a different code may be more appropriate.

6. Documentation requirements

When reporting CPT code 20902, the following documentation should be included:

• Clear indication of the major or large bone defect requiring the bone graft
• Description of the donor area from which the bone graft was obtained
• Date of the procedure
• Details of the surgical technique used, including any specific instruments or devices
• Method of wound closure
• Any additional relevant information or complications encountered during the procedure

7. Billing guidelines

When billing for CPT code 20902, it is important to ensure that the procedure performed meets the criteria for a major or large bone defect. This code should not be reported for smaller defects or other types of grafting procedures. It is also important to follow any specific guidelines or requirements set forth by the payer or insurance company.

8. Historical information

CPT code 20902 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. Examples

1. A patient with a major bone defect in their tibia undergoes a bone graft procedure using a segment of the fibula.
2. A surgeon performs a bone graft to address a large bone defect in a patient’s mandible.
3. A patient with a major bone defect in their humerus receives a bone graft using a segment of the iliac crest.
4. A bone graft procedure is performed to address a large bone defect in a patient’s scapula.
5. A patient with a major bone defect in their femur undergoes a bone graft using a segment of the rib.
6. A surgeon performs a bone graft to address a large bone defect in a patient’s radius.
7. A patient with a major bone defect in their ulna receives a bone graft using a segment of the fibula.
8. A bone graft procedure is performed to address a large bone defect in a patient’s clavicle.
9. A patient with a major bone defect in their pelvis undergoes a bone graft using a segment of the iliac crest.
10. A surgeon performs a bone graft to address a large bone defect in a patient’s skull.