How To Use CPT Code 20969

CPT code 20969 describes the procedure of performing a free osteocutaneous flap with microvascular anastomosis using grafts obtained from sites other than the iliac crest, metatarsal, or great toe. 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 20969?

CPT code 20969 is used to report the performance of a free osteocutaneous flap with microvascular anastomosis using grafts obtained from sites other than the iliac crest, metatarsal, or great toe. This procedure involves the harvest of bone graft material along with its active vascular supply, arteries and veins, and an attached layer of cutaneous tissue or skin. The purpose of this procedure is to fill a bony defect at the recipient site and compensate for soft tissue loss caused by trauma or disease.

2. Official Description

The official description of CPT code 20969 is: ‘Free osteocutaneous flap with microvascular anastomosis other than iliac crest, metatarsal, or great toe.’

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. An incision is made at the graft site, extending through the fascia and muscle layers down to the bone.
3. A piece of bone along with the layer of skin above it is excised, taking care to preserve and dissect the vascular blood supply along with the dissected bone.
4. The recipient site is debrided and any necrotic tissue is removed.
5. The extracted graft is brought into the operative field and placed in position.
6. Microvascular anastomosis is performed, attaching the vascular supply of the bone graft to the bone of the recipient site using microsurgery techniques.
7. The donor and recipient sites are closed with layered sutures.

4. Qualifying circumstances

CPT code 20969 is used when performing a free osteocutaneous flap with microvascular anastomosis using grafts obtained from sites other than the iliac crest, metatarsal, or great toe. This procedure is typically performed to address bony defects and compensate for soft tissue loss caused by trauma or disease. It is important to note that this code specifically excludes grafts obtained from the iliac crest, metatarsal, or great toe.

5. When to use CPT code 20969

CPT code 20969 should be used when performing a free osteocutaneous flap with microvascular anastomosis using grafts obtained from sites other than the iliac crest, metatarsal, or great toe. It is important to ensure that the procedure meets the specific criteria outlined in the code description.

6. Documentation requirements

To support a claim for CPT code 20969, the following documentation is required:

• Preoperative diagnosis
• Procedure performed
• Specific sites from which the grafts were obtained
• Description of the procedure, including any additional details or modifications
• Any complications encountered during the procedure
• Postoperative diagnosis
• Any postoperative care provided
• Signature of the performing physician

7. Billing guidelines

When billing for CPT code 20969, ensure that the procedure meets the specific criteria outlined in the code description. It is important to accurately document the details of the procedure and any associated complications or postoperative care provided. Additionally, be aware of any specific billing guidelines or requirements set forth by payers or regulatory bodies.

8. Historical information

CPT code 20969 was added to the Current Procedural Terminology system on January 1, 1990. It has undergone several changes, including being added to the Inpatient Only (IPO) list in 2017 and subsequently removed from the IPO list in 2021. However, it was added back to the IPO list in 2022.

9. Examples

1. A patient undergoes a free osteocutaneous flap with microvascular anastomosis using grafts obtained from the fibula to address a bony defect in the lower leg.
2. A patient undergoes a free osteocutaneous flap with microvascular anastomosis using grafts obtained from the scapula to reconstruct a defect in the jaw.
3. A patient undergoes a free osteocutaneous flap with microvascular anastomosis using grafts obtained from the radius to address a bony defect in the forearm.
4. A patient undergoes a free osteocutaneous flap with microvascular anastomosis using grafts obtained from the tibia to reconstruct a defect in the lower leg.
5. A patient undergoes a free osteocutaneous flap with microvascular anastomosis using grafts obtained from the humerus to address a bony defect in the upper arm.
6. A patient undergoes a free osteocutaneous flap with microvascular anastomosis using grafts obtained from the fibula to reconstruct a defect in the foot.
7. A patient undergoes a free osteocutaneous flap with microvascular anastomosis using grafts obtained from the scapula to address a bony defect in the shoulder.
8. A patient undergoes a free osteocutaneous flap with microvascular anastomosis using grafts obtained from the radius to reconstruct a defect in the hand.
9. A patient undergoes a free osteocutaneous flap with microvascular anastomosis using grafts obtained from the tibia to address a bony defect in the lower leg.