February 28, 2019
My surgeon performed a repair of a nonunion with bone graft harvested via a separate incision. The surgeon submitted CPT code 25431 alone. I added CPT code 20902 after reviewing the operative note, because the surgeon obtained the bone graft from a distant site via a separate incision. My surgeon disagrees with me and is firm that the harvest of the bone graft is not separately reportable. Shouldn’t we be able to report the bone graft in addition to 25431 because of the separate incision?
We appreciate your question! Although your physician did do the work of harvesting the bone graft from a separate incision, the rules associated with this code do not allow reporting 20902 (Bone graft, any donor area; major or large)
CPT code 25431 (Repair of nonunion of carpal bone (excluding carpal scaphoid (navicular)) (includes obtaining graft and necessary fixation), each bone) states in its definition the instructions “includes obtaining graft and necessary fixation).
You are correct that if a graft is obtained via a separate incision and is not inclusive to the code definition, or is not inclusive to a typical procedure, that the bone graft may be reportable in addition to the primary procedure. For example, when a surgeon performs a subtalar arthrodesis defined by CPT code 28725 (Arthrodesis; subtalar) and harvests a bone graft from the proximal tibia, both 28725 and the bone graft (e.g. 20900 or 20902) may be reported.
*This response is based on the best information available as of 2/28/19.