11/30/2005    Dan Greenan, DPM

Bone Biopsy

Query: Bone Biopsy

What would be the correct code to use for a bone
biopsy of a distal phalanx to rule out
osteomyelitis?

Dan Greenan, DPM, Burien, WA

Codingline Response: Assuming the only procedure
performed on the distal phalanx was a bone
biopsy, the procedure, depending on technique,
would either be coded CPT 20220 (biopsy, bone,
trocar, or needle; superficial); or CPT 20240
(biopsy, bone, open; superficial).

Harry Goldsmith, DPM, Cerritos, CA

Other messages in this thread:

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05/08/2006    Steven Adler, DPM

Bone Biopsy Coding

Query: Bone Biopsy Coding

I am looking for the proper CPT code for a bone
biopsy. The biopsy
was performed with a Jamshidi needle, through a
minimal incision.

Please let me know if the code changes for
different parts of the
foot.

Steven Adler, DPM, Pearl River, NY

Response: CPT 20220 - biopsy, bone, trocar, or
needle; superficial
(e.g., ilium, sternum, spinous process, ribs) 
specifically defines
the procedure you performed.

Because access to bone on the foot would be
superficial, and you are
neither describing performance of a bone marrow
biopsy nor an open
bone biopsy, CPT 20220 would be the code for any
separate needle
removal of bone for biopsy exam performed on the
foot.

Harry Goldsmith, DPM, Cerritos, CA

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08/08/2005    Robert Tinsley, DPM

Bone Biopsy Denial

Query: Bone Biopsy Denial

We did a bone biopsy on a patient with suspected
osteomyelitis.
The surgery performed was:

1) Removal of two 4.0 cannulated screws from the
distal aspect of the right great toe.
2) Bone biopsy, distal tuft of the distal
phalanx, right great toe.
3) Culture for culture and sensitivity same
site.
4) Avulsion of right great toenail.

We charged CPT 11730 (nail avulsion), CPT 20680
(removal of buried, deep, hardware) & CPT 20225
(biopsy, bone, trocar, or needle; deep [e.g.,
vertebral body, femur]). We were paid on the
first two, but Medicare denied the bone biopsy
(CPT 20225) stating this cannot be performed by
this type of physician. Do you know or have any
suggestions on what we might try to get
reimbursed for the bone biopsy? Any suggestions
would be greatly appreciated.

Kathy, Office of Robert Tinsley, DPM
Viera, FL

I suspect that the reason for the denial is the
procedure code chosen.
Given the descriptor, the carrier likely
believed it to be outside of the scope of
practice of a podiatrist. The area biopsied
(phalanx, toe) should probably be coded as CPT
20220 (biopsy, bone, trocar, or needle;
superficial [e.g., ilium, sternum, spinous
process, ribs) since it is not a major or
particularly deep bone.

Stacey Hernandez
Woodland Hills, CA

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04/16/2004    Tejas R. Pandya, DPM

Billing For Bone Biopsy

Query: Billing For Bone Biopsy

What would be the appropriate codes for a bone
biopsy taken of the distal phalanx, proximal
phalanx and 1st metatarsal right foot?

Tejas R. Pandya, DPM
Troy, NY

Codingline Reponses:The bones are considered
superficial, and the codes that would apply
would be either CPT 20220 (if a needle or
trochar is used to obtain a superficial bone
biopsy) or CPT 20240 (when the bone biopsy is
superficial, but performed open). .

Walter J Pedowitz MD
Linden, NJ

I have had no success in being reimbursed when
billing CPT 20220 (biopsy, bone, trocar, or
needle; superficial [eg, ilium, sternum, spinous
process, ribs] under Medicare in New York as
they have a computer edit in place which denies
this as 'not covered by this provider'.

If you have a similar problem with the code, I
would urge you to contact your CAC rep (in New
York, it is Dr. Mark Schilansky) for further
advice.

Paul Kesselman, DPM
Woodside, NY