How To Use CPT Code 20970

CPT code 20970 describes the procedure for a free osteocutaneous flap with microvascular anastomosis using grafts obtained from the iliac crest. 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 20970?

CPT 20970 is a code used to describe the procedure for a free osteocutaneous flap with microvascular anastomosis using grafts obtained from the iliac crest. This procedure involves harvesting bone graft material from the iliac crest, along with its active vascular supply and an attached layer of cutaneous tissue or skin. The graft is then used to fill a bony defect at the recipient site and compensate for soft tissue loss due to trauma or disease.

2. Official Description

The official description of CPT code 20970 is: ‘Free osteocutaneous flap with microvascular anastomosis iliac crest.’

3. Procedure

The procedure for CPT code 20970 involves several steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision in the skin over the graft site of the iliac crest and extends it down to the bone.
3. A piece of bone along with the layer of skin above it is excised.
4. The provider preserves and dissects the vascular blood supply along with the dissected bone.
5. The bone graft, along with its intact skin and vascular supply, is prepared.
6. The provider debrides and removes any necrotic tissue at the recipient site.
7. The extracted graft is placed in position at the recipient site.
8. Microvascular anastomosis is performed, which involves joining the arteries and veins of the graft with the local vessels using microsurgery techniques.
9. The provider closes both the donor and recipient sites with layered sutures.

4. Qualifying circumstances

CPT code 20970 is used for patients who require a free osteocutaneous flap with microvascular anastomosis using grafts obtained from the iliac crest. 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 procedure requires the use of microsurgery techniques and should not be reported with code 69990, which is used for microsurgical techniques performed in addition to the primary procedure.

5. When to use CPT code 20970

CPT code 20970 should be used when a provider performs a free osteocutaneous flap with microvascular anastomosis using grafts obtained from the iliac crest. This code is specific to this procedure and should not be used for other similar procedures or techniques.

6. Documentation requirements

To support a claim for CPT code 20970, the provider must document the following information:

• Patient’s diagnosis and the need for the procedure
• Details of the procedure performed, including the specific steps and techniques used
• Date of the procedure
• Start and end time of the procedure
• Any complications or additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 20970, ensure that the procedure performed meets the criteria described in the code description. It is important to note that this code should not be reported with code 69990, which is used for microsurgical techniques performed in addition to the primary procedure. Additional tips for billing CPT code 20970 may include specific modifiers or considerations based on payer guidelines.

8. Historical information

CPT code 20970 was added to the Current Procedural Terminology system on January 1, 1990. There have been several changes to the code’s status, 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 the code.

9. Similar codes to CPT 20970

While there are no similar codes specifically related to CPT code 20970, there may be other codes that describe similar procedures or techniques for addressing bony defects and soft tissue loss. It is important to review the code set and documentation guidelines to determine the most appropriate code for a specific procedure.

9. Examples

1. A patient undergoes a free osteocutaneous flap with microvascular anastomosis using grafts obtained from the iliac crest to address a bony defect caused by trauma.
2. A provider performs a free osteocutaneous flap with microvascular anastomosis using grafts obtained from the iliac crest to compensate for soft tissue loss due to disease.
3. A patient requires a free osteocutaneous flap with microvascular anastomosis using grafts obtained from the iliac crest to address a complex bony defect resulting from a previous surgical procedure.
4. A provider performs a free osteocutaneous flap with microvascular anastomosis using grafts obtained from the iliac crest to reconstruct a bony defect caused by a tumor resection.
5. A patient undergoes a free osteocutaneous flap with microvascular anastomosis using grafts obtained from the iliac crest to address a congenital bone deformity.
6. A provider performs a free osteocutaneous flap with microvascular anastomosis using grafts obtained from the iliac crest to reconstruct a bony defect caused by infection.
7. A patient requires a free osteocutaneous flap with microvascular anastomosis using grafts obtained from the iliac crest to address a bony defect resulting from a non-union fracture.
8. A provider performs a free osteocutaneous flap with microvascular anastomosis using grafts obtained from the iliac crest to reconstruct a bony defect caused by avascular necrosis.
9. A patient undergoes a free osteocutaneous flap with microvascular anastomosis using grafts obtained from the iliac crest to address a bony defect resulting from a failed previous reconstructive procedure.
10. A provider performs a free osteocutaneous flap with microvascular anastomosis using grafts obtained from the iliac crest to reconstruct a bony defect caused by a congenital malformation.