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Orthopedic Coding Alert

Reader Questions:

Look to 20975 for Invasive Bone Healing Stimulator

Question: Our physician inserted a bone healing stimulator. How should we report this service?

Washington, D.C., Subscriber
Answer: Medicare and most third-party payers recommend that you report 20975 (Electrical stimulation to aid bone healing; invasive [operative]) when the orthopedic surgeon inserts an internal bone stimulator to aid healing.

Physicians often insert stimulators following procedures such as spinal fusion (for instance, 22612, Arthrodesis, posterior or posterolateral technique, single level; lumbar [with or without lateral transverse technique]).
Most insurers only cover the internal stimulator for nonunion of long bone fractures, and as an adjunct to spinal fusion surgery.

Most payers accept ICD-9 code 733.82 (Nonunion of fracture [pseudoarthrosis] [bone]) when the physician inserts internal or external bone stimulators.

If the surgeon applies an external bone stimulator, report 20974 (Electrical stimulation to aid bone healing; noninvasive [nonoperative]).

Most payers will cover an external bone stimulator for nonunion of long bone fractures; for failed fusion, when a minimum of nine months has elapsed since the last surgery; for congenital pseudoarthroses; and as an adjunct to spinal fusion surgery for patients at high risk of pseudoarthrosis due to previously failed fusion at the same site or for those undergoing multiple-level fusion.

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