Summary & Overview
CPT 20245: Open Bone Biopsy, Surgical Diagnostic Procedure
CPT code 20245 denotes an open bone biopsy, a surgical diagnostic procedure used to obtain bone tissue samples from lesions for pathological or infectious disease evaluation. This code is clinically important because bone biopsy results directly influence diagnosis, staging, and treatment decisions for malignancy, infection, and metabolic bone disorders. Nationally, accurate coding for open bone biopsy affects clinical documentation, utilization metrics, and claims adjudication across major payers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the procedure, typical sites of service, and the payer landscape. The publication also outlines commonly used billing modifiers associated with procedural coding and highlights benchmarking elements and policy considerations relevant to reimbursement and claims processing.
The report is designed to inform billing managers, surgical teams, and policy analysts about coding expectations, the role of the procedure in care pathways, and areas where payer policies commonly affect coverage and documentation. Data not available in the input will be identified explicitly in specific sections of the full publication.
Billing Code Overview
CPT code 20245 describes an open bone biopsy, a surgical procedure to obtain a sample of bone tissue, typically from a lesion, for pathological or microbiological analysis. The service type is a surgical diagnostic procedure aimed at definitive tissue diagnosis. The typical site of service is an operating room or procedure room within an inpatient or outpatient surgical setting, depending on clinical indication and patient status.
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Clinical & Coding Specifications
Clinical Context
A 58-year-old male presents with persistent, focal bone pain and a radiographic lytic lesion of the proximal femur noted on X-ray and MRI. The referring orthopedic surgeon suspects a neoplastic process (primary bone tumor vs metastatic disease) and schedules an open bone biopsy to obtain a representative specimen for histopathology, microbiology, and ancillary testing. Pre-procedure workflow includes informed consent, pre-anesthesia assessment (general or regional anesthesia commonly used), and site marking. In the operating room, the surgeon exposes the lesion through an open incision, visually inspects and palpates the area, obtains core and wedge samples of bone and surrounding soft tissue, achieves hemostasis, closes in layers, and sends specimens to pathology and culture. Post-procedure workflow includes recovery from anesthesia, pain management, wound care instructions, and arranging follow-up for pathology results and any further oncologic or infectious disease workup.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or complexity substantially exceeds typical for the procedure due to extensive dissection or atypical anatomy |
23 | Unusual anesthesia |