CPT code 20245 is for an open deep bone biopsy, a procedure where a sample of bone tissue is surgically removed for examination.
CPT code 20245 is for a bone biopsy that is performed through an open surgical procedure, targeting deep bone tissue. This means that the physician makes an incision to access and remove a sample of bone from a deeper location within the body for diagnostic purposes.
When billing for CPT code 20245 (Bone biopsy, open; deep), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of potential modifiers that could be used with CPT code 20245, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more work than typically required. This could be due to factors such as patient complexity or unexpected complications.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the bone biopsy was performed on both sides of the body during the same operative session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures, including the bone biopsy, are performed during the same surgical session. This helps indicate that the procedures are distinct and separate.
4. Modifier 52 - Reduced Services
- This modifier is appropriate if the procedure was partially reduced or eliminated at the physician's discretion. For example, if the biopsy was planned but not fully completed due to patient safety concerns.
5. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the bone biopsy was a distinct service from other procedures performed on the same day. This is particularly important if the biopsy is performed in a different anatomical site or through a separate incision.
6. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same physician needs to repeat the bone biopsy procedure on the same day due to unforeseen circumstances.
7. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if a different physician repeats the bone biopsy procedure on the same day.
8. Modifier 78 - Unplanned Return to the Operating Room
- This modifier is used if the patient needs to return to the operating room for a related procedure during the postoperative period of the initial surgery.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if the bone biopsy is performed during the postoperative period of another surgery but is unrelated to the initial procedure.
10. Modifier LT - Left Side
- Use this modifier to specify that the bone biopsy was performed on the left side of the body.
11. Modifier RT - Right Side
- Use this modifier to specify that the bone biopsy was performed on the right side of the body.
12. Modifier 99 - Multiple Modifiers
- This modifier is used when more than four modifiers are necessary to describe the service accurately. It indicates that additional modifiers are listed in the documentation.
Proper use of these modifiers ensures that the billing accurately reflects the services provided, which can help avoid claim denials and ensure appropriate reimbursement. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
Is CPT Code 20245 Reimbursed by Medicare?
Yes, CPT code 20245, which refers to an open deep bone biopsy, is reimbursed by Medicare. The reimbursement amount can vary based on several factors, including geographic location and specific Medicare Administrative Contractor (MAC) policies. As of the latest available data, the national average reimbursement for CPT code 20245 is approximately $500. However, it is essential to verify the exact reimbursement rate with your local MAC, as rates can fluctuate and may be subject to annual updates.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments, even down to specific CPT codes like 20245 for bone biopsy open deep. Ensure you're receiving the full reimbursement you deserve from every payer. Schedule a demo today to see RevFind in action and protect your revenue.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
