How To Use CPT Code 20955

CPT 20955 describes the procedure of obtaining a bone graft from the fibula, along with its active vascular supply, to fill a major bone defect at the recipient site. 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 20955?

CPT 20955 is a code that describes the procedure of obtaining a bone graft from the fibula, along with its active vascular supply, to fill a major bone defect at the recipient site. This procedure involves the use of microvascular anastomosis, which ensures the graft’s vascular supply is connected to the recipient site, promoting faster healing and growth.

2. Official Description

The official description of CPT code 20955 is: ‘Bone graft with microvascular anastomosis fibula.’

3. Procedure

The procedure for CPT 20955 involves several steps:

1. The provider makes a longitudinal incision at the donor graft site over the soleus and the long fibular muscle of the leg.
2. The incision is extended down to the level of fascia and muscle.
3. Muscle tissue is incised and retracted to expose the grafting area on the fibula.
4. The provider localizes the fibular bone and performs a proximal and distal osteotomy to dissect a piece of bone from the fibula.
5. Special care is taken to preserve and dissect the vascular blood supply along with the dissected bone.
6. The provider ensures satisfactory preparation of the bone graft along with intact vascular supply and sutures the donor site in a layered fashion.
7. The extracted graft is brought into the operative field of the recipient site.
8. Microvascular anastomosis is performed, attaching the vascular supply of the bone graft to the bone of the recipient site.
9. The bone graft is fitted into the defect area of the recipient site and affixed with bone plates, screws, and bone paste.
10. The recipient site is closed using layered sutures.

4. Qualifying circumstances

CPT 20955 is performed when there is a major bone defect that requires a bone graft with microvascular anastomosis. This procedure is typically used to compensate for bone loss due to trauma or disease, particularly in the forearm or tibia. The patient must meet the specific criteria for this procedure, and the provider must determine that it is medically necessary.

5. When to use CPT code 20955

CPT code 20955 should be used when a bone graft is obtained from the fibula, along with its active vascular supply, to fill a major bone defect at the recipient site. This code is specific to the procedure described and should not be used for other bone grafting procedures or microvascular anastomosis performed in different anatomical locations.

6. Documentation requirements

To support a claim for CPT 20955, the provider must document the following information:

• Justification for the procedure, including the presence of a major bone defect
• Details of the procedure, including the specific steps performed
• Documentation of microvascular anastomosis and the connection of the vascular supply
• Any additional procedures performed in conjunction with CPT 20955
• Any complications or unexpected findings during the procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 20955, ensure that the procedure meets the specific criteria outlined in the code description. It is important to accurately document the procedure and any additional services provided. CPT 20955 should not be reported with other codes unless there are separate and distinct procedures performed. It is essential to follow the specific guidelines provided by the payer to ensure proper reimbursement.

8. Historical information

CPT 20955 was added to the Current Procedural Terminology system on January 1, 1990. It has undergone several changes, including being added and removed from the Inpatient Only (IPO) list for Medicare. It is important to stay updated on any changes or updates to ensure accurate coding and billing.

9. Similar codes to CPT 20955

There are several similar codes to CPT 20955 that may be used for different bone grafting procedures or microvascular anastomosis in other anatomical locations. Some similar codes include:

• CPT 20953: Bone graft, any donor area; minor or small (eg, dowel or button)
• CPT 20954: Bone graft, any donor area; intermediate (eg, osteotomy, autograft harvesting, allograft preparation, microvascular bone transfer)
• CPT 20956: Bone graft, any donor area; segmental, with or without compression plate
• CPT 20957: Bone graft, any donor area; morselized (eg, screws, pins, wires, staples, or other fixation devices are not used to affix the graft to the recipient site)

9. Examples

1. A patient with a major bone defect in the forearm undergoes a bone graft with microvascular anastomosis using the fibula as the donor site.
2. A patient with a tibial bone defect receives a bone graft with microvascular anastomosis using the fibula to promote healing and growth at the recipient site.
3. A provider performs a bone graft with microvascular anastomosis using the fibula for a patient with bone loss due to trauma in the forearm.
4. A patient with a major bone defect in the tibia undergoes a bone graft with microvascular anastomosis using the fibula to restore bone integrity and promote healing.
5. A provider performs a bone graft with microvascular anastomosis using the fibula for a patient with bone loss in the forearm caused by disease.
6. A patient with a major bone defect in the tibia receives a bone graft with microvascular anastomosis using the fibula to facilitate bone regeneration and healing.
7. A provider performs a bone graft with microvascular anastomosis using the fibula for a patient with bone loss in the forearm due to a previous surgical procedure.