CPT® Code 20933 | Case2Code

Official Description

Allograft, includes templating, cutting, placement and internal fixation, when performed; hemicortical intercalary, partial (ie, hemicylindrical) (List separately in addition to code for primary procedure)

Common Language Description

The CPT® Code 20933 refers to the procedure of allografting, which involves the use of donor tissue to reconstruct a bone or soft tissue deficit. This procedure is particularly relevant in cases where there is a need to address significant bone loss due to various medical conditions such as tumors, osteochondral cysts, posttraumatic or degenerative arthritis, traumatic injuries, or avascular necrosis. The primary goal of this intervention is to prevent limb amputation and to preserve the functionality of the limb. The allograft utilized in this procedure is typically derived from cadaveric sources and is composed of bone, cartilage, or other tissues that closely resemble the anatomical structure of the tissue being replaced. During the allografting process, the affected area is accessed surgically, and the damaged or diseased tissue is resected down to viable, healthy bone or tissue. The allograft is then meticulously sculpted to match the contours of the removed tissue, using the excised bone or tissue as a template. Once shaped, the allograft is inserted into the prepared site and secured in place using various fixation methods, which may include rods, cerclage wires, intramedullary nails, plates, or screws. The procedure can involve either a partial (hemicortical or hemicylindrical) or complete (cylindrical) intercalary allograft, depending on the extent of the bone deficit. In the case of hemicortical intercalary allografting, the diaphyseal portion of the bone is resected while preserving the length of the bone, allowing for the allograft to be attached in the area of the partial deficit. Conversely, complete intercalary allografting involves the total removal of a section of the diaphyseal bone, with the allograft bridging the gap between the remaining ends of the native bone. It is important to note that this code is used in conjunction with the primary procedure code for radical resection of the diseased bone or joint or for implant removal.

1. Indications

The procedure associated with CPT® Code 20933 is indicated for various conditions that result in significant bone or soft tissue deficits. These include:

Tumors - The presence of bone tumors may necessitate the removal of affected bone tissue, leading to the need for reconstruction.
Osteochondral cysts - These cysts can cause damage to the bone and cartilage, requiring surgical intervention to restore structural integrity.
Posttraumatic or degenerative arthritis - Conditions resulting from trauma or degeneration can lead to substantial bone loss, making allografting a viable option for repair.
Traumatic injury - Severe injuries that compromise bone integrity may require reconstruction to maintain limb function.
Avascular necrosis - This condition, characterized by the death of bone tissue due to a lack of blood supply, often necessitates surgical intervention to prevent further complications.

2. Procedure

The procedure for CPT® Code 20933 involves several critical steps to ensure successful allografting. These steps include:

Step 1: Surgical Access - The first step involves accessing the affected area of the bone. This is typically achieved through an incision that allows the surgeon to visualize and reach the damaged tissue.
Step 2: Resection of Damaged Tissue - Once access is obtained, the surgeon carefully resects the damaged or diseased bone or soft tissue down to viable, healthy tissue. This step is crucial to ensure that the allograft will have a solid foundation for integration.
Step 3: Allograft Preparation - The allograft, which is usually derived from cadaveric sources, is then sculpted to match the contours of the resected area. The surgeon uses the excised bone or tissue as a template to shape the allograft appropriately.
Step 4: Insertion of the Allograft - After preparation, the allograft is inserted into the prepared site. This step requires precision to ensure proper placement and alignment with the surrounding bone.
Step 5: Fixation - Finally, the allograft is secured in place using appropriate fixation devices such as rods, cerclage wires, intramedullary nails, plates, or screws. This fixation is essential for the stability of the graft and to promote healing and integration with the host bone.

3. Post-Procedure

Post-procedure care following the allografting procedure is critical for successful recovery and integration of the allograft. Patients may require monitoring for signs of infection, proper wound care, and pain management. Rehabilitation may be necessary to restore function and strength to the affected limb. The duration of recovery can vary based on the extent of the procedure and the individual patient's healing process. Follow-up appointments are essential to assess the integration of the allograft and to ensure that the patient is progressing appropriately in their recovery.

Short Descr	HEMICRT INTRCLRY ALGRFT PRTL
Medium Descr	HEMICORTICAL INTERCALARY ALLOGRAFT PARTIAL
Long Descr	Allograft, includes templating, cutting, placement and internal fixation, when performed; hemicortical intercalary, partial (ie, hemicylindrical) (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)	2 - Payment restriction for assistants at surgery does not apply 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)	none
MUE	1

This is an add-on code that must be used in conjunction with one of these primary codes.

23210	MPFS Status: Active Code APC C Illustration for Code Radical resection of tumor; scapula
23220	MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Radical resection of tumor, proximal humerus
24150	MPFS Status: Active Code APC J1 CPT Assistant Article Illustration for Code Radical resection of tumor, shaft or distal humerus
25170	MPFS Status: Active Code APC J1 CPT Assistant Article Illustration for Code Radical resection of tumor, radius or ulna
27075	MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Radical resection of tumor; wing of ilium, 1 pubic or ischial ramus or symphysis pubis
27076	MPFS Status: Active Code APC C Illustration for Code Radical resection of tumor; ilium, including acetabulum, both pubic rami, or ischium and acetabulum
27077	MPFS Status: Active Code APC C Illustration for Code Radical resection of tumor; innominate bone, total
27365	MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Radical resection of tumor, femur or knee
27645	MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Radical resection of tumor; tibia
27704	MPFS Status: Active Code APC Q2 ASC A2 Illustration for Code Removal of ankle implant

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
GC	This service has been performed in part by a resident under the direction of a teaching physician
LT	Left side (used to identify procedures performed on the left side of the body)
RT	Right side (used to identify procedures performed on the right side of the body)