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Medicare denial codes 20936 and 20930

Annie Posted Wed 29th of October, 2014 08:49:49 AM

We have billed multiple claims to Medicare for spinal fusions and they are denying the use of codes 20936 and 20930. Can you give me some insight into whether there are a different set of codes to be used for demineralized bone matrix and autograft bone taken from the spinous process for arthrodesis.

SuperCoder Answered Wed 29th of October, 2014 09:56:00 AM

Thanks for your question. 20930; Allograft, morselized, or placement of osteopromotive material, for spine surgery only and 20936; Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision are both add on codes for a major spinal procedure. CMS will not pay separately for these two codes. They are considered to be a component of the major spinal procedure. There are also no RVUs assigned to these two codes. Your commercial carriers may pay separately for these two codes. You should check your payer policies to determine which commercial payers will reimburse separately for these codes. See attached link regarding spinal bone grafts for additional information. Hope this helps.

https://www.supercoder.com/coding-newsletters/my-orthopedic-coding-alert/coding-tips-ace-spinal-bone-graft-coding-with-these-expert-pointers-108464-article

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