CPT code 20939 is a medical code used to describe a bone marrow aspiration for bone grafting.
CPT code 20939 is used for the procedure involving the aspiration (removal) of bone marrow for the purpose of bone grafting. This code specifically refers to the process where bone marrow is extracted to be used in a graft, which can help in the healing and regeneration of bone tissue.
When billing for CPT code 20939 (Bone marrow aspir bone grafting), 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 20939, 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 increased intensity, time, technical difficulty, or the patient's condition.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the bone marrow aspiration and grafting procedure was performed on both sides of the body during the same session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures, including 20939, are performed during the same surgical session. This helps indicate that more than one procedure was carried out.
4. Modifier 59 - Distinct Procedural Service
- This modifier is used to indicate that the bone marrow aspiration and grafting was a distinct procedural service from other services performed on the same day. It helps to avoid bundling issues and ensures separate reimbursement.
5. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same physician repeats the bone marrow aspiration and grafting procedure on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if a different physician repeats the bone marrow aspiration and grafting procedure on the same day.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Use this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period of the initial bone marrow aspiration and grafting.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial bone marrow aspiration and grafting.
9. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was necessary for the bone marrow aspiration and grafting procedure.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier if an assistant surgeon was required due to the unavailability of a qualified resident surgeon.
11. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier if a non-physician practitioner assisted in the bone marrow aspiration and grafting procedure.
12. Modifier LT - Left Side
- Apply this modifier if the bone marrow aspiration and grafting was performed on the left side of the body.
13. Modifier RT - Right Side
- Use this modifier if the bone marrow aspiration and grafting was performed on the right side of the body.
Properly applying these modifiers can help ensure accurate billing and reimbursement for CPT code 20939. Always verify payer-specific guidelines, as requirements may vary.
Medicare reimbursement for CPT code 20939, which pertains to bone marrow aspiration for bone grafting, is subject to specific guidelines and conditions. As of the latest updates, Medicare does reimburse for this procedure, but the reimbursement amount can vary based on several factors, including geographic location, the setting in which the procedure is performed, and any applicable modifiers.
To determine the exact reimbursement amount for CPT code 20939, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS) or use the Medicare Administrative Contractor (MAC) resources specific to their region. These resources provide the most accurate and up-to-date information on reimbursement rates.
For a precise figure, providers can also use the CMS Physician Fee Schedule Look-Up Tool available on the Centers for Medicare & Medicaid Services (CMS) website. This tool allows providers to input the CPT code and other relevant details to obtain the current reimbursement rate.
In summary, CPT code 20939 is reimbursed by Medicare, but the exact amount can be determined by consulting the MPFS or the CMS Look-Up Tool.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 20939 for bone marrow aspir bone grafting. 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
