In 2018, reporting of orthopedic spinal procedures will be impacted by the addition of one code and deletion and revision of some musculoskeletal system codes and spine and spinal cord codes. The assistance of a reliable medical coding service can be invaluable to handle these changes, ensure clean claims, and optimize reimbursement.Orthopedic Spinal Surgery

New CPT code

Effective January 1, 2018, orthopedic practices are using a new CPT code – 20939.

20939 Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision (to be listed separately in addition to code for primary procedure)

Previously, CPT code 38220 (Bone marrow aspiration) was used to report this service.

New CPT code 20939 applies to harvesting of bone marrow for the purposes of bone grafting via separate skin or fascial incision.

Points to note:

  • 20939 is not a standalone code and should be used in conjunction with spinal arthrodesis codes such as:
    • 22532, Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic
    • 22533, Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar
    • 22548, Arthrodesis, anterior transoral or extraoral technique, clivus-C1-C2 (atlas-axis), with or without excision of odontoid process
    • 22551, Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2
    • 22554, Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); cervical below C2
    • 22556, Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace. (other than for decompression); thoracic
    • 22558, Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar
  • For a bilateral procedure, 20939 should be used with modifier 50
  • 20999 should be used for aspiration of bone marrow for the purpose of bone grafting, other than spine surgery and other therapeutic musculoskeletal applications
  • “For diagnostic bone marrow aspiration(s), see 38220, 38222”

Deleted CPT Code

Effective January 1, 2018, the following code has been deleted:

  • 0309T – Arthrodesis, pre-sacral interbody technique, including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft, when performed, lumbar, L4-L5 interspace (List separately in addition to code for primary procedure

Code Revision

CPT code 38220 Diagnostic bone marrow; aspiration (s) has been revised to report diagnostic bone marrow aspiration only.

Points to note:

  • 38220 should not be reported in conjunction with 38221
  • 38222 is to be used for diagnostic bone marrow biopsy[ies] and aspiration[s] performed at the same session
  • 20939 should be used for aspiration of bone marrow for bone graft, spine surgery only
  • 0232T should be used for bone marrow aspiration[s] for platelet-rich stem cell injection

Other Key Changes

Instruction notes have been added to the following CPT codes:

  • 20225 Biopsy, bone, trocar, or needle; deep (eg, vertebral body, femur)
    New instructional note: “For bone marrow biopsy(ies) and/or aspiration(s), see 38220, 38221, 28222”.
  • Injection or Removal (CPT codes 20500-20664)
    New instruction note: “For injection of autologous adipose-derived regenerative cells, see 0489T, 0490T”.
  • 20900-20939 Grafts (or Implants)
    New instructional note: “Codes for obtaining autogenous bone, cartilage, tendon, fascia lata grafts, bone marrow, or other tissues through separate skin/fascial incision should be reported separately, unless the code descriptor references the harvesting of the graft or implant (eg, includes obtaining graft)”.
  • CPT Code Changes for Orthopedic Spinal Surgery20926 Tissue grafts, other (eg, paratenon, fat, dermis)
    New instructional note: “Do not report code 20692 in conjunction with 0489T, 0490T”, “For harvesting of adipose tissue for autologous adipose-derived regenerative cell therapy, see 0489T, 0490T”, “For injection of autologous adipose-derived regenerative cells, see 0489T, 0490T”, “For harvesting, preparation, and injection(s) of platelet-rich plasma, use 0232T”.
  • 20938 Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision) (List separately in addition to code for primary procedure
    New instructional note: “For bone marrow aspiration for bone grafting, spine surgery only, use 20939”.
  • New instructional notes have also been added for: Application of Casts and Strapping; CPT code 29540 Strapping; ankle and/or foot; CPT code 29580 Strapping; Unna boot; CPT code 29581 Application of multi-layer compression system; leg (below knee), including ankle and foot; Anterior or Anterolateral Approach for Extradural Exploration/Decompression; Lateral Extracavitary Approach for Extradural Exploration/Decompression; and Excision, Anterior or Anterolateral Approach, Intraspinal Lesion.

In addition to the changes for spine surgery, orthopedic practices have to prepare for both CPT and ICD-10 code changes in 2018, such as those for nerve repair, ultrasound, and finger and toe injuries. They need to understand how new billing rules impact ortho practices and learn strategies to deal with them. Partnering with en experienced medical billing and coding company is the best option to manage these challenges.