CPT code 20920 is the removal of fascia for graft, a procedure where tissue is taken from one area to be used in another.
CPT code 20920 is for the removal of fascia, which is a type of connective tissue, to be used as a graft in surgical procedures. This code is used when a surgeon takes a piece of fascia from one part of the body to use it in another area that needs repair or reinforcement.
For CPT code 20920 (Removal of fascia for graft), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or other factors that increased the complexity of the surgery.
2. Modifier 50 - Bilateral Procedure: If the removal of fascia for graft is performed on both sides of the body, this modifier should be used to indicate a bilateral procedure.
3. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier should be used to indicate that 20920 is one of several procedures.
4. Modifier 59 - Distinct Procedural Service: Use this modifier when the procedure is distinct or independent from other services performed on the same day. This is often used to indicate that the removal of fascia for graft is separate from other procedures.
5. Modifier 76 - Repeat Procedure by Same Physician: If the same physician needs to repeat the removal of fascia for graft procedure, this modifier should be used.
6. Modifier 77 - Repeat Procedure by Another Physician: If a different physician repeats the procedure, this modifier should be applied.
7. Modifier 78 - Unplanned Return to the Operating Room: If the patient needs to return to the operating room for a related procedure during the postoperative period, this modifier should be used.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if the removal of fascia for graft is performed during the postoperative period of another procedure but is unrelated to the initial surgery.
9. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier should be used.
10. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon is required for the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): If an assistant surgeon is necessary because a qualified resident surgeon is not available, this modifier should be applied.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Use this modifier when these healthcare professionals assist in the surgery.
Each of these modifiers serves a specific purpose and should be used according to the guidelines to ensure accurate billing and reimbursement.
Medicare does reimburse for CPT code 20920, which pertains to the removal of fascia for graft. The reimbursement amount can vary based on geographic location and other factors, but as of the latest data, the national average reimbursement rate for this procedure is approximately $300. It's important to verify the specific reimbursement rate with your local Medicare Administrative Contractor (MAC) to ensure accuracy.
Discover how MD Clarity's RevFind software can meticulously read your contracts and detect underpayments down to the CPT code level, including specific codes like 20920 for the removal of fascia for graft. Ensure you're receiving the full reimbursement you deserve from every payer. Schedule a demo today to see how RevFind can optimize your revenue cycle management.
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