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The CPT® Code 20938 refers to the procedure of performing an autograft specifically for spine surgery. This procedure involves the use of an autologous bone graft, which is harvested from the patient's own body, ensuring compatibility and reducing the risk of rejection. The graft can be obtained from various locations, including the ribs, spinous process, or lamina, and may be harvested through the same incision made for the primary spinal surgery. Alternatively, it can be harvested from a remote site, such as the iliac crest, through a separate incision. The autologous bone graft is rich in osteoblasts, which are essential for bone growth, and contains bone morphogenic proteins that facilitate the formation of new bone. This graft provides a calcium scaffolding that supports the growth of new bone tissue. The procedure described by CPT® Code 20938 specifically involves the use of structural bone grafts that are bicortical or tricortical in nature, which means they consist of both cortical and cancellous bone. The harvested bone is shaped to fit the defect in the spine and is secured in place, often using screws or wires, to promote effective healing and integration with the surrounding bone tissue. This code is used in conjunction with the primary procedure code, as it is reported separately to account for the additional surgical effort involved in harvesting and placing the graft.
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The procedure associated with CPT® Code 20938 is indicated for various conditions requiring spinal surgery where structural support is necessary. The following are the explicitly provided indications for performing an autograft in spine surgery:
The procedure for CPT® Code 20938 involves several critical steps to ensure the successful harvesting and placement of the autograft:
After the procedure associated with CPT® Code 20938, the patient will typically be monitored for any immediate complications. Post-operative care may include pain management, physical therapy, and instructions for activity restrictions to promote healing. The expected recovery time can vary based on the individual patient's condition and the extent of the surgery performed. Follow-up appointments will be necessary to assess the healing process and ensure that the graft is integrating properly with the surrounding bone. Any signs of infection, graft failure, or complications should be reported to the healthcare provider promptly for further evaluation and management.
| Short Descr | SP BONE AGRFT STRUCT ADD-ON | Medium Descr | AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC | Long Descr | Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision) (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) | 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 | 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). | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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. | 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. | 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). | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | 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) | SG | Ambulatory surgical center (asc) facility service |
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| 2013-01-01 | Changed | Guideline information changed. |
| 2008-01-01 | Changed | Code description changed. |
| 1996-01-01 | Added | Code added |
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