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The CPT® Code 20931 refers to the use of a structural allograft specifically for spine surgery. In this context, an allograft is a type of bone graft that utilizes donor bone, typically harvested from a cadaver. This procedure is distinct in that it involves the placement of an intact piece of donor bone, which has been carefully shaped or sculpted to fit into a specific bone defect within the spine. Unlike other grafts, such as those that may contain living cells or growth factors, a structural allograft primarily serves as a calcium scaffold. This scaffold allows for the natural process of bone growth to occur around it, a phenomenon known as bone conduction. Additionally, the term 'osteopromotive material' is often associated with this procedure. These materials are designed to promote bone growth and may include substances that contain natural growth factors, which can stimulate the differentiation of cells into bone-forming cells. One notable example is bone morphogenic proteins (BMP), which are combined with absorbable collagen sponges to enhance the graft's effectiveness in inducing new bone formation. It is important to note that CPT® Code 20931 is used exclusively for reporting the placement of structural allografts in spine surgery and should be listed separately in addition to the primary procedure code, ensuring accurate billing and documentation of the surgical intervention.
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The placement of a structural allograft, as described by CPT® Code 20931, is indicated for various conditions affecting the spine that require surgical intervention. These indications may include:
The procedure involving the placement of a structural allograft in spine surgery follows several critical steps, which are outlined as follows:
After the placement of a structural allograft, patients typically undergo a recovery period that may involve monitoring for any complications, such as infection or graft failure. Post-operative care often includes pain management, physical therapy, and follow-up appointments to assess the healing process. Patients are usually advised on activity restrictions to avoid undue stress on the surgical site, allowing for optimal integration of the allograft with the surrounding bone. The expected recovery time can vary based on the individual’s overall health and the complexity of the surgical procedure performed.
| Short Descr | SP BONE ALGRFT STRUCT ADD-ON | Medium Descr | ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL | Long Descr | Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No 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 | Items and Services Packaged into APC Rates | ASC Payment Indicator | Packaged service/item; no separate payment made. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3D - Major procedure, orthopedic - other | MUE | 1 | CCS Clinical Classification | 161 - Other OR therapeutic procedures on bone |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 22319 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; with grafting | 22532 | MPFS Status: Active Code APC C Physician Quality Reporting Illustration for Code Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic | 22533 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar | 22548 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Arthrodesis, anterior transoral or extraoral technique, clivus-C1-C2 (atlas-axis), with or without excision of odontoid process | 22551 | MPFS Status: Active Code APC J1 ASC J8 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2 | 22552 | Addon Code MPFS Status: Active Code APC N ASC N1 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2, each additional interspace (List separately in addition to code for primary procedure) | 22554 | MPFS Status: Active Code APC J1 ASC J8 Physician Quality Reporting CPT Assistant Article Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); cervical below C2 | 22556 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic | 22558 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar | 22590 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Arthrodesis, posterior technique, craniocervical (occiput-C2) | 22595 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Arthrodesis, posterior technique, atlas-axis (C1-C2) | 22600 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Arthrodesis, posterior or posterolateral technique, single interspace; cervical below C2 segment | 22610 | MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Arthrodesis, posterior or posterolateral technique, single interspace; thoracic (with lateral transverse technique, when performed) | 22612 | MPFS Status: Active Code APC J1 ASC J8 Physician Quality Reporting CPT Assistant Article Illustration for Code Arthrodesis, posterior or posterolateral technique, single interspace; lumbar (with lateral transverse technique, when performed) | 22630 | MPFS Status: Active Code APC J1 Physician Quality Reporting CPT Assistant Article Illustration for Code Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace, lumbar; | 22633 | MPFS Status: Active Code APC J1 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace, lumbar; | 22634 | Addon Code MPFS Status: Active Code APC N Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace, lumbar; each additional interspace (List separately in addition to code for primary procedure) | 22800 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Arthrodesis, posterior, for spinal deformity, with or without cast; up to 6 vertebral segments | 22802 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to 12 vertebral segments | 22804 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Arthrodesis, posterior, for spinal deformity, with or without cast; 13 or more vertebral segments | 22808 | MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Arthrodesis, anterior, for spinal deformity, with or without cast; 2 to 3 vertebral segments | 22810 | MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Arthrodesis, anterior, for spinal deformity, with or without cast; 4 to 7 vertebral segments | 22812 | MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Arthrodesis, anterior, for spinal deformity, with or without cast; 8 or more vertebral segments |
| AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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. | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CR | Catastrophe/disaster related | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | LT | Left side (used to identify procedures performed on the left side of the body) | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | SA | Nurse practitioner rendering service in collaboration with a physician | SG | Ambulatory surgical center (asc) facility service | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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Action
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Notes
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| 2013-01-01 | Changed | Guideline information changed. |
| 2011-01-01 | Changed | Long description revised. |
| 2008-01-01 | Changed | Code description changed. |
| 1996-01-01 | Added | First appearance in code book in 1996. |
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