CPT code 20936 is for a spinal bone graft, local, add-on. It is used to describe a specific medical procedure for billing and documentation.
CPT code 20936 is used for a surgical procedure involving a spinal bone graft. This code specifically refers to the use of a local bone graft, which means the bone used for the graft is taken from the same surgical site or nearby area. It is considered an add-on code, meaning it is used in conjunction with another primary procedure code and cannot be billed on its own.
When using CPT code 20936 for a spinal bone autograft (local add-on), several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:
1. Modifier 59 (Distinct Procedural Service): Used to indicate that the procedure is distinct or independent from other services performed on the same day. This modifier is often used to prevent bundling of services that are typically considered part of a comprehensive procedure.
2. Modifier 51 (Multiple Procedures): Applied when multiple procedures are performed during the same surgical session. This modifier helps to indicate that the procedure is one of several performed.
3. Modifier 62 (Two Surgeons): Used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure. This modifier is necessary when the complexity of the procedure requires the skills of two surgeons.
4. Modifier 76 (Repeat Procedure by Same Physician): Indicates that a procedure or service was repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
5. Modifier 77 (Repeat Procedure by Another Physician): Used when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
6. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): This modifier is used when a patient requires a return to the operating room for a related procedure during the postoperative period of the initial surgery.
7. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Indicates that a procedure or service performed during the postoperative period was unrelated to the original procedure.
8. Modifier 22 (Increased Procedural Services): Applied when the work required to provide a service is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
9. Modifier 24 (Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period): Used to report an evaluation and management service performed during a postoperative period for a reason unrelated to the original procedure.
10. Modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service): Indicates that on the day a procedure or service was performed, the patient's condition required a significant, separately identifiable evaluation and management service above and beyond the other service provided.
These modifiers help to provide additional information about the circumstances under which the CPT code 20936 was used, ensuring accurate billing and reimbursement.
Medicare does reimburse for CPT code 20936, which refers to a spinal bone autograft, local, add-on procedure. However, the reimbursement amount can vary based on several factors, including geographic location, the specific Medicare Administrative Contractor (MAC) processing the claim, and the setting in which the procedure is performed (e.g., hospital outpatient, inpatient, or ambulatory surgical center).
As of the most recent data, the national average reimbursement rate for CPT code 20936 under the Medicare Physician Fee Schedule (MPFS) is approximately $200. However, it is crucial to verify the exact reimbursement rate through the Medicare Physician Fee Schedule Look-Up Tool or consult your local MAC for the most accurate and up-to-date information.
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