CPT code 20970 is a medical code used to describe a bone or skin graft procedure from the iliac crest.
CPT code 20970 is used for a procedure involving a bone or skin graft taken from the iliac crest, which is part of the pelvic bone. This code is specifically used to document and bill for the surgical process where bone or skin is harvested from this area to be used in another part of the body, often to aid in healing or reconstruction.
When billing for CPT code 20970 (Bone/skin graft iliac crest), it is important 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 20970, 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. Documentation must support the increased complexity.
2. Modifier 50 (Bilateral Procedure):
- Apply this modifier if the bone/skin graft was performed bilaterally. This indicates that the procedure was performed on both sides of the body.
3. Modifier 51 (Multiple Procedures):
- Use this modifier when multiple procedures are performed during the same surgical session. This helps to indicate that more than one procedure was carried out.
4. Modifier 59 (Distinct Procedural Service):
- This modifier is used to indicate that the bone/skin graft was a distinct procedural service from other services performed on the same day. It helps to avoid bundling issues.
5. Modifier 62 (Two Surgeons):
- Apply this modifier if two surgeons worked together as primary surgeons performing distinct parts of the procedure. Each surgeon should report their specific part of the procedure.
6. Modifier 76 (Repeat Procedure by Same Physician):
- Use this modifier if the same physician needs to repeat the bone/skin graft procedure on the same day or within a short period.
7. Modifier 77 (Repeat Procedure by Another Physician):
- This modifier is used if a different physician repeats the bone/skin graft procedure on the same day or within a short period.
8. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period):
- Apply this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period):
- Use this modifier if the bone/skin graft is performed during the postoperative period of another, unrelated procedure.
10. Modifier 80 (Assistant Surgeon):
- This modifier is used when an assistant surgeon is required to help with the procedure.
11. Modifier 81 (Minimum Assistant Surgeon):
- Apply this modifier if an assistant surgeon provides minimal assistance during the procedure.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)):
- Use this modifier if an assistant surgeon is required because a qualified resident surgeon is not available.
13. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery):
- This modifier is used when a non-physician provider assists in the surgery.
Proper use of these modifiers ensures that the billing accurately reflects the services provided and helps in obtaining appropriate reimbursement. Always refer to the latest coding guidelines and payer-specific requirements for the most accurate and up-to-date information.
Medicare reimbursement for CPT code 20970, which pertains to a bone or skin graft from the iliac crest, depends on several factors including medical necessity, the setting in which the procedure is performed, and the specific Medicare plan. Generally, Medicare Part B may cover this procedure if it is deemed medically necessary and performed in an outpatient setting. However, the reimbursement amount can vary based on geographic location and other factors.
To determine the exact reimbursement amount, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS) or contact their Medicare Administrative Contractor (MAC). As of the latest updates, the reimbursement amount for CPT code 20970 can range significantly, so it is crucial to verify the current rates.
For precise and up-to-date information, providers should consult the CMS website or their specific Medicare contractor.
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 20970 for bone/skin graft iliac crest. Ensure you're receiving the full reimbursement you're entitled to from each payer. Schedule a demo today to see how RevFind can optimize your revenue cycle management.
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
