Resolved Grafts, morselized or structural?

[CCO_Bot]

Question:

joseyj62114:
"code +20930 allograft, morselized, or placement of osteopromotive material, for spine surgery only."
is this the same as 'bone chips"? what is the difference between 'morselized' and 'structural'? Any help appreciated.

Answer Thread:

Laureen:
bone chips are the structural ones - morselized is more like crushed or smaller pieces.

joseyj62114:

bone chips are the structural ones - morselized is more like crushed or smaller pieces.

Hi, Laureen! I learned so much from your video lectures. My textbook confuses me. So far I understand allografts come moralized or structural, +20930, +20931. Your clarification is bone chips are the structural ones. So, here is what my textbook says "Autogenous bone was used for a graft (autograft), and then supplemented with bone chips (allograft). In the CPT Index to Diseases, look for Spine/Allograft. The selection is between moralized and structural. Bone chips were used, indicating it was moralized, which directs you to 20930." This last sentence seems conflicting. Would the op report identify the allograft as moralized or structural? If so, then it would be easy for me to select the correct code. But if the op reports says 'bone chips', I would select +20931. According to the book, it would be incorrect.

Laureen:
Ok digging more on this one...

I found this article at the AAPC http://news.aapc.com/index.php/2013/09/procedure-coding-made-simple/ and it says:

From the operative note, determine whether the bone graft was an allograft or an autograft, and whether it was a morselized (bits or pieces) or structural (wedge or chunk) bone. It helps to know what the bone type documented in the operative note looks like.

Oh if only it came out ans said "chips".

Here is another http://news.aapc.com/index.php/2009/03/complete-spinal-fusion-coding-includes-grafting-and-more/

3. Was the graft a single piece of bone (structural), or did it consist of several—or many—smaller pieces (morselized)? For example, along with posterior cervical laminectomy, the surgeon may pack morselized bone in open areas on either side of the spine and in the facet joint spaces to promote new bone growth.

Again no mention of "chips" - is it a single piece of bone? or many smaller pieces? I could argue both ways - sigh - still looking...

After reading several op reports online it seems a common practice to take a bone chip and then morselize it.

Here is a Supercoder article quote:

3. Confirm if a single "structural" piece of bone or if multiple small pieces were used for grafting. If your surgeon used a single bone as a graft, you select a 'structural' bone graft (+20931 and +20938). If, however, your surgeon uses multiple small fragments of bone to promote new bone growth and fill up a cavity in the spine, you select one of the codes for morselized grafts (+20930 and +20937). "Structural grafts are used for support and when large segments of bone are missing. Morselized grafts or cancellous chips are used to heal smaller defects," says Mallon.

Ok so based on that I'm retracting my earlier statement and have concluded that chips = morselized. I learned something new - thank you!

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