Understanding CPT 20220 - Under General Excision Procedures on the Musculoskeletal System
Introduction
The introduction to an article about the 20220 CPT code could be as follows:
"In the comprehensive landscape of medical procedures, CPT (Current Procedural Terminology) codes play a crucial role in categorizing and standardizing medical interventions. Among these, the 20220 CPT code is specifically designated for bone biopsy procedures that aim to evaluate the bone matrix structure. Accompanied by CPT code 88307 for surgical pathology interpretation, this code represents a critical component in the diagnosis and treatment planning for various bone-related conditions. This article delves into the intricacies and applications of the 20220 CPT code, shedding light on its significance in the realm of bone biopsy and medical diagnostics."
We will be using iVECoder's online real-time AI Engine to find up to date CPT Code information based on AMA and CMS guidelines. If you wish to gain a demonstration of the software or purchase a license, here are the links:
20220 CPT Code definition
Related Codes You Need to Know about 20220 cpt
A quick search in our database will show you the following HCPCS codes which include CPT: 19499 through 20225. Each code will have CMS short and long descriptions with active or terminated dates. You can see that 20220 is a current and valid HCPCS code to use at this time.
AMA Description and Layperson Definition of CPT 20220
Per CMS Definition of CPT 20220
Biopsy, bone, trocar, or needle; superficial (eg, ilium, sternum, spinous process, ribs).
CMS Status of CPT 20220
These codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an "A" indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy.
Layperson's Definition for Beginners:
CPT 20220 is the biopsy of bone using needle or trocar.
There are AMA definitions and layperson’s definitions, we’ll provide both.
AMA definition of 49000 is Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure).
The layperson’s term is Exploration of the abdominal cavity.
49000 cpt code’s CMS Status is active and is paid separately under the physician fee schedule if covered. There will be RVUs for codes with this status. The presence of an "A" indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy.
Adjudication Details of CPT Code 20220
CPT Code 49000 is part of the diagnostic family is 99 and has an MUE count of 3, and HOS MUE count of 3.
GPCI should be properly set up in iVECoder and your billing software. You can foresee Non-facility RVU, calculating your Non-facility versus Facility.
Per CMS Modifiers for CPT 20220 would not apply for 26/TC, the 150% Medicare rule does not apply for Modifier 50 with 20220. However, modifier 51 with 20220 would have standard payment reductions. You should note that modifier 62 and 66 (co-surgeons and team surgeons, respectively) are not permitted per CMS. Lastly, modifier 80 has a statutory payment restriction.
Fianancial Details with billing cpt 20220
We used Maryland as an example, but remember to adjust your GPCI within your iVECoder and/or billing software to ensure accurate financial details. As you can see the Non-Facility RV Total is $245.82 while the Facility Total RVU is $89.21. Let's say though for financial sake, you have a contract that pays out 115% Medicare, what would those totals be? iVECoder will do that for you. See pic below:
APC and ASC relating to CPT 20220
Related HCPCS Codes and Modifiers for 20220 CPT
There are 272 Outpatient Bundled Codes associated with CPT 20220. Unbundling these can lead to denials, audits, and fines. Make sure you use a code scrubber like iVECoder to help you sort through the endless revisions CMS expects us to know and apply every day.
There are 196 Outpatient CCI Bundled Codes codes related to CPT 20220. Make sure you know these codes as to not unbundle and face a denial and then costly and timely appeal.
Acceptable modifiers for CPT Code 20220
These are initial modifiers used for CPT 20220. However, there are over 64 modifiers in total that can be used.
What places of service is 49000 CPT Code authorized for payment?
Remember that using the right place of service doesn't mean that you can't re-bill it and get paid for when facing a denial for cpt 20220, however, it can bring forth potential audits for fraud and abuse, as well as your clinic enduring the time and fees associated with appeals.
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Summary of CPT Code 20220
There are hundreds if not thousands of related codes, modifiers, and things to consider in submitting your next claim for cpt code 20220. Please take the time to look at the visit notes, history, and utilize iVECoder to help you bill your next 20220 cpt clean claim to your payer.
Will Schmidt joined PCG Software as their Chief Strategy Officer in November 2022. Prior to PCG, Schmidt lead TNH as their Sr. Vice President to become the 7th largest pharmacy in the nation. He then went on to consult with and serve as Interim CEO or Consultant to over 20 different companies specializing in profit strategies, operational efficiencies, vendor relations and partnerships, and exit strategies, include an international Revenue Cycle Management Company.
