2025 CPT code 20955
(Active) Effective Date: N/A Revision Date: N/A Surgical Procedures on the Musculoskeletal System - Other Procedures on the Musculoskeletal System Surgery Feed
Bone graft with microvascular anastomosis; fibula.
Modifiers may be applicable depending on the circumstances.For example, modifier 51 (multiple procedures) could be used if additional procedures are performed during the same surgical session.Modifier 76 (repeat procedure by the same physician) may apply if the procedure is repeated due to complications.
Medical necessity is established when a significant bone defect exists that cannot be adequately addressed with other methods, requiring bone grafting to restore structural integrity, function, and prevent complications such as nonunion or delayed union.The use of a vascularized fibular graft with microvascular anastomosis offers superior healing compared to nonvascularized grafts, especially in large defects.
The surgeon is responsible for pre-operative planning, including assessing the need for a vascularized fibular graft, selecting the appropriate donor and recipient sites, and performing the entire procedure including the microvascular anastomosis.Post-operative care and follow-up are also the responsibility of the surgeon.
- Surgery
- Musculoskeletal System > Surgical Procedures on the Musculoskeletal System > General Surgical Procedures on the Musculoskeletal System > Other Procedures on the Musculoskeletal System
In simple words: The doctor takes a piece of bone from the leg (fibula) with its blood vessels attached to fill a big hole in another bone.They carefully connect the blood vessels of the bone piece to the blood vessels in the area to make sure the transplanted bone gets enough blood to heal quickly.
This procedure involves harvesting a segment of the fibula bone along with its attached vascular supply (arteries and veins) to be used as a bone graft.The harvested graft is then transferred to a recipient site with a significant bone defect, where microvascular anastomosis (surgical connection of small arteries and veins) is performed to ensure the graft receives adequate blood supply, promoting healing and integration. The procedure includes donor site preparation (incision, dissection, osteotomy), graft harvesting with preservation of the vascular pedicle, microvascular anastomosis at the recipient site, graft placement and fixation (e.g., with plates, screws, bone paste), and closure of both donor and recipient sites.
Example 1: A patient sustains a severe tibia fracture with significant bone loss following a motorcycle accident. A vascularized fibular graft with microvascular anastomosis (20955) is necessary to reconstruct the defect and restore bone continuity., A patient with a large bone cyst in the humerus requires bone grafting to fill the void created after curettage. A vascularized fibular graft with microvascular anastomosis (20955) is used due to the size of the defect and the need for rapid healing., A patient with a bone tumor undergoes resection. The resulting bone defect necessitates reconstruction using a vascularized fibular graft with microvascular anastomosis (20955) to provide structural support and improved healing.
Preoperative imaging (X-rays, CT scans) demonstrating the bone defect, operative report detailing the procedure (including donor site preparation, graft harvesting, microvascular anastomosis, graft placement, fixation, and closure), postoperative imaging confirming graft placement and vascularity, and pathology report if applicable.
** The success of this procedure depends heavily on the surgeon's skill in microvascular anastomosis and meticulous attention to detail throughout the procedure.Post-operative monitoring is crucial to detect and treat potential complications such as graft necrosis or infection.
- Payment Status: Active
- Specialties:Orthopedic Surgery, Plastic Surgery, Microsurgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center