Summary & Overview
CPT 20240: Open Superficial Bone Biopsy
CPT code 20240 represents an open, superficial bone biopsy: a surgical diagnostic procedure to obtain bone tissue for laboratory analysis when infection, tumor, or other bone pathology is suspected. Nationally, accurate coding of this procedure affects clinical documentation, appropriate site-of-service reporting, and claims adjudication for both commercial payers and government programs.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for when an open superficial bone biopsy is used, common sites of service, and the types of documentation that support medical necessity. The publication also outlines benchmarking and policy considerations relevant to reimbursement and reporting, including typical claims elements and payer-specific policy implications where available. Data not available in the input is noted explicitly where applicable.
This summary is intended for clinicians, coding professionals, and policy analysts seeking a concise national overview of CPT code 20240, its clinical role, and the billing and policy topics typically associated with open superficial bone biopsy procedures.
Billing Code Overview
CPT code 20240 describes an open, superficial bone biopsy, a surgical procedure performed to obtain a bone tissue sample for diagnostic analysis, including evaluation for infection, tumor, or other bone pathology. The procedure typically involves a minor open incision to expose the bone surface and remove a representative specimen for laboratory testing.
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Service type: Surgical diagnostic procedure
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Typical site of service: Outpatient surgical center or hospital outpatient department; may also be performed in an inpatient setting depending on clinical context.
Clinical & Coding Specifications
Clinical Context
A 62-year-old male with a history of chronic left hip pain and an elevated inflammatory marker is referred to orthopedics after plain radiographs suggest a possible osteomyelitis of the proximal femur. After review of prior imaging and failed conservative management, the orthopedic surgeon schedules an open, superficial bone biopsy under monitored anesthesia care to obtain bone tissue for culture and histopathology to confirm infection and guide antimicrobial therapy. The clinical workflow includes preoperative consent and review of anticoagulation, pre-op antibiotics per institutional protocol withheld until tissue is obtained if infection is suspected, intraoperative acquisition of a targeted superficial bone specimen through a small open incision with meticulous hemostasis, submission of separate samples for aerobic, anaerobic, mycobacterial, and histopathologic studies, and postoperative wound care with outpatient follow-up to review culture and pathology results and plan definitive management (antibiotics or further surgical debridement).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure | Use when a distinct E/M was provided the same day as the biopsy and is documented separately |
50 | Bilateral procedure | Use when identical open superficial bone biopsies are performed on paired bones during the same operative session |
51 | Multiple procedures | Use when the biopsy is one of multiple distinct procedures performed during the same operative episode (subject to payer bundling rules) |
52 | Reduced services | Use when the biopsy is partially reduced or not fully performed as described (documentation must support) |
53 | Discontinued procedure | Use when the biopsy was started but discontinued due to extenuating circumstances or safety concerns |
59 | Distinct procedural service | Use to indicate a separate and distinct procedure when multiple procedures in the same anatomic region might be bundled |
62 | Two surgeons | Use when two surgeons of different specialties share the operative procedure in a documented, separate manner |
76 (represented by 73 in the provided list — use 73 if applicable) | Repeat procedure by same physician | Use when the procedure is repeated later the same day by the same physician (note: 73 actually denotes discontinued outpatient/ambulatory procedure prior to anesthesia; because 73 appears in the list it is used when an outpatient/ambulatory procedure is discontinued prior to anesthesia administration) |
79 | Unrelated procedure or service by the same physician during the postoperative period | Use when the biopsy is unrelated to the original procedure during global period |
LT | Left side | Use to designate the left anatomic site when laterality is required |
RT | Right side | Use to designate the right anatomic site when laterality is required |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
2080P0000X | Orthopedic Surgery | Orthopedic surgeons commonly perform open bone biopsies, especially of long bones and periarticular lesions |
207L00000X | Pathology | Pathologists evaluate the specimen microscopically and oversee ancillary testing; laboratory taxonomy included for completeness |
207K00000X | Diagnostic Radiology | Radiologists may assist with localization or perform image-guided biopsies; open biopsies follow radiologic localization |
2086S0105X | Infectious Disease | Infectious disease specialists interpret microbiology results and recommend antimicrobial therapy when infection is suspected |
208D00000X | General Surgery | General surgeons may perform open superficial bone biopsies in certain anatomic locations |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M86.172 | Acute hematogenous osteomyelitis, left femur | Common indication for open bone biopsy to obtain culture and direct therapy |
M86.171 | Acute hematogenous osteomyelitis, right femur | Same relevance for opposite laterality |
M86.9 | Osteomyelitis, unspecified | Used when site or chronicity is not yet classified at time of biopsy |
C41.4 | Malignant neoplasm of pelvic bones, sacrum, coccyx, and associated joints | Biopsy may be performed to obtain tissue for diagnosis of suspected primary bone malignancy |
M80.8 | Other specified osteoporosis with current pathological fracture | Biopsy may be obtained when a pathological fracture raises concern for underlying malignancy or infection |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
11010 | Debridement of skin, subcutaneous tissue and muscle, including surface wound, with or without removal of foreign material and drainage, extensive; typically used for infected or necrotic soft tissue | Performed when concurrent soft tissue debridement is required at the biopsy site |
27614 | Incision and drainage, deep abscess, bursa or hematoma, leg (eg, calf, ankle) | May be performed if the biopsy is part of addressing a deep-seated infectious collection adjacent to bone |
11100 | Biopsy of single skin lesion; trunk, arms, legs; single lesion | Performed for concurrent skin lesion biopsy when adjacent skin pathology is evaluated alongside superficial bone biopsy |
11011 | Debridement, major (eg, soft tissue) | Used when extensive soft tissue debridement accompanies the open bone biopsy |
20550 | Injection(s); single tendon sheath, ligament, or ganglion cyst | May be performed in the same encounter for diagnostic or therapeutic management of adjacent soft-tissue pathology |