Orthopedic Coding in ICD-10-PCS: Allografts and Autografts

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Snapshot ICD-10: Weekly Updates & Tips

This Week’s Snapshot: Orthopedic Coding on ICD-10-PCS: Allografts and Autografts

By Holly Cassano, CPC

Anyone who is involved in the business of medical billing and coding knows that ICD-10-CM and ICD-10-PCS will be effective as of Oct. 1, 2014, and so should be making appropriate preparations for continuing education in order to be ready to bill and code medical services when ICD-10 commences.

ICD-10-PCS is the coding system that will replace ICD-9-CM Volume 3, which is currently used for facility coding of inpatient procedures on hospital inpatients. Items such as disease prevention, identification of diagnoses, treatment plans, and case management, all will fall under this umbrella of ICD-10-PCS.

There are roughly 87,000 codes in ICD-10 compared to the current 4,000 in ICD-9-CM. Of these codes, less than 65% have an exact match in ICD-10-PCS. So billers and coders must remember there will not always be a one-to-one relationship.

As I discussed in last Friday’s article here, bone graft procedures are a common occurance in orthopedics. As in ICD-9/ CPT-4, these procedures often present volumes of confusion for billers/coders when tasked with proper billing and coding for these procedures.

There are a variety of graft types, and sometimes they are combined during a procedure, depending on the clinical condition that needs surgical repair. Bone grafts are utilized for a number of procedures, as they assist in a patient’s recovery time amongst a variety reasons, including structural support, correction of deformities, and reconstruction.

Graft Types

Autografts

  • CPT 20936 – Localized autograft (same incision) for spine surgery only (includes harvesting the graft); local (e.g., ribs, spinous process, or laminar fragments). List separately in addition to code for primary procedure.
  • CPT 20937 – Localized autograft (separate incision) for spine surgery only (includes harvesting the graft); morselized (List separately in addition to code for primary procedure). Billed/coded with 38220-59.

Allografts

  • CPT 20930 – Morselized allograft that is purchased
  • CPT 20931 – Structural allograft that is purchased

Fact: Only one bone graft code from this section can be billed per case.

Bone Grafts in ICD-9 3:

78.00, 78.09 – Bone graft of other bone, except facial bones

Bone is defined as:

  • Bank graft
  • Graft (autogenous)(heterogenous)
  • That with debridement of bone graft site (removal of sclerosed, fibrous, or necrotic bone or tissue)
  • Transplantation of bone
  • Code also any excision of bone for graft (77.70-77.79)
  • That for bone lengthening (78.30-78.39)

ICD-10-PCS Tip: Check for specificity for all codes that require the addition of a fourth, fifth, sixth, or seventh character.

The following sequence of codes from ICD-10-PCS represent code alternatives, root operations, and body system descriptions for lumbar vertebrae procedures that utilize a graft procedure, harvested either from a donor or from the patient. The approach is indicated, as in CPT-4 currently, as ICD-10-PCS represents inpatient procedural coding.

Code Alternatives and Root Operation / Body System: Description Supplement for Lumbar Vertebra

  • 0QU0/ Root Operation/Body System
  • Found in the Medical/Surgical Section of ICD-10-PCS
  • 78.09 0QU03KZ Supplement Lumbar Vertebra with Nonautologous Tissue Substitute, Percutaneous Approach
  • 78.00, 78.09 0QU037Z Supplement Lumbar Vertebra with Autologous Tissue Substitute, Percutaneous Approach
  • 78.09 0QU00KZ Supplement Lumbar Vertebra with Nonautologous Tissue Substitute, Open Approach
  • 78.00, 78.09 0QU047Z Supplement Lumbar Vertebra with Autologous Tissue Substitute, Percutaneous Endoscopic Approach
  • 78.00, 78.09 0QU007Z Supplement Lumbar Vertebra with Autologous Tissue Substitute, Open Approach
  • 78.09, 80.29 0QU04KZ Supplement Lumbar Vertebra with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach

Final Thoughts
ICD-10 is upon us, and the best way to ensure proper understanding of billing and coding accurately and to ensure correct payment is to continue to review and practice your billing and coding skills and to continue expanding your knowledge base of this coding convention, as it is on the horizon.

Happy Coding!

Holly

Reference Note: ICD-10-PCS code descriptions provided by Optum Encoder Pro E Solutions. See here.

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