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The procedure described by CPT® Code 20920 involves the harvesting of a fascia lata graft, which is a specialized type of tissue taken from the deep fascia of the thigh. The fascia lata is known for its strength and is often utilized in various reconstructive surgical procedures. In this specific technique, a device known as a stripper is employed to facilitate the separation of the fascia from the underlying muscle tissue. The process begins with the creation of a horizontal incision, typically located above the knee, along the iliotibial tract, which is a band of connective tissue that runs along the outer thigh. This incision allows access to the fascial layer beneath the skin. To initiate the harvesting, a small incision is made in the fascia itself, and a silk suture is placed at the proximal edge of this incision. This suture serves a crucial role in assisting the physician to thread the fascia strip through the stripper device. Once the stripper is engaged, it is pushed along the fascia in a superior direction while tension is applied to the silk suture, effectively pulling the fascia through the stripper. The physician continues this process until a strip of fascia of the desired length is obtained. At this point, the stripper is triggered to cut the strip proximally, allowing for the collection of multiple strips if necessary. This method is particularly advantageous for obtaining grafts that are needed for subsequent surgical reconstruction, ensuring that the harvested tissue is both adequate in size and quality for the intended use.
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The fascia lata graft harvesting procedure described by CPT® Code 20920 is indicated for various surgical scenarios where strong, durable tissue is required for reconstruction. The following conditions may warrant the use of this procedure:
The harvesting of the fascia lata graft using a stripper device involves several detailed steps to ensure the successful collection of the tissue. The procedure begins with the physician making a horizontal incision above the knee, specifically over the iliotibial tract. This incision is carefully carried down to the fascial layer, providing access to the fascia lata. Following this, a small incision is made in the fascia itself, and a silk suture is placed at the proximal edge of this incision. This suture is essential as it allows for the threading of the fascia strip through the stripper device.
Once the silk suture is in place, the stripper device is engaged. The physician then pushes the stripper along the fascia in a superior direction while simultaneously applying tension to the silk suture. This action effectively pulls the fascia through the stripper, allowing for the harvesting of the graft. The physician continues this process until a strip of fascia of the desired length is obtained. When the appropriate length is achieved, the stripper is triggered to cut the strip proximally, completing the harvesting process. It is important to note that multiple strips of fascia may be harvested during this procedure, depending on the requirements of the subsequent surgical intervention.
After the fascia lata graft has been harvested, the incision made during the procedure is closed to promote healing. A drain may be placed at the site to prevent fluid accumulation, which is a common consideration in surgical procedures involving tissue harvesting. Additionally, a pressure dressing is applied to the area to support the healing process and minimize swelling. Post-procedure care is crucial to ensure proper recovery, and patients are typically monitored for any signs of complications, such as infection or excessive bleeding. The expected recovery time may vary based on individual patient factors and the extent of the surgical intervention that follows the graft harvesting.
| Short Descr | REMOVAL OF FASCIA FOR GRAFT | Medium Descr | FASCIA LATA GRAFT BY STRIPPER | Long Descr | Fascia lata graft; by stripper | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5B - Ambulatory procedures - musculoskeletal | MUE | 1 | CCS Clinical Classification | 160 - Other therapeutic procedures on muscles and tendons |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | RT | Right side (used to identify procedures performed on the right side of the body) |
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| Pre-1990 | Added | Code added. |
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