2025 CPT code 20938
(Active) Effective Date: N/A Revision Date: N/A Surgery - Spinal Surgery Musculoskeletal System Feed
Preparation and application of structural autograft for spine surgery; obtained through a separate incision.
Modifiers 53 (discontinued procedure), 58 (staged or related procedure), 59 (distinct procedural service), 76 (repeat procedure), and 78 (unplanned return to OR) may be applicable depending on the circumstances of the procedure.
Medical necessity is established through clinical documentation demonstrating the presence of a significant bone defect in the spine requiring grafting for stabilization or structural support.The defect should be related to the underlying spinal condition necessitating the surgical intervention.
The surgeon is responsible for selecting the donor site (iliac crest, rib, or femoral head), harvesting the autograft, preparing the graft, and implanting it into the spinal defect during the spinal surgery.
In simple words: The doctor uses the patient's own bone to fill in gaps in the spine during back surgery.They take the bone from another part of the body through a separate cut.
This CPT code, 20938, represents the preparation and application of a structural autograft (bone graft harvested from the patient's own body) during spinal surgery.The autograft is obtained through a separate incision from the primary surgical site. The code includes the harvesting, preparation, and application of the graft.It does not encompass the primary spinal surgical procedure itself, but rather the supplemental bone grafting component.
Example 1: A patient undergoes spinal fusion for spondylolisthesis.The surgeon uses 20938 to code the harvesting and implantation of an iliac crest autograft to supplement the fusion procedure., During a laminectomy for spinal stenosis, the surgeon uses 20938 to code the harvesting and placement of a rib autograft to address a bony defect at the surgical site., A patient requires a posterior cervical fusion for cervical spondylosis. The surgeon uses 20938 to code the use of a femoral head autograft harvested from the patient's leg, to augment the fusion.
Detailed operative report specifying the donor site, type and quantity of bone harvested, preparation method, and placement of the graft.Imaging studies (pre- and post-operative) should show the location and extent of the bone defect and the graft placement.
** The CMS Physician Fee Schedule Database indicates that the concept of bilateral surgery does not apply to this code.If the procedure is performed bilaterally, report the code twice.
- Revenue Code: P3D (MAJOR PROCEDURE, ORTHOPEDIC - OTHER)
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Orthopedic Surgery, Neurosurgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center