Summary & Overview
CPT 20922: Fascia Lata Graft Harvest, Open Excision
CPT code 20922 identifies the open excision harvest of fascia lata grafts from the thigh, used when larger or complex sheet grafts are required for tendon repair, chest wall or orbital reconstruction, or procedures such as unilateral gluteoplasty for fecal incontinence. This surgical harvesting code matters nationally because it is billed in a range of reconstructive and reparative procedures where autologous fascial tissue provides structural support that synthetic materials may not. Proper coding affects procedural grouping, payment, and the clinical documentation that supports use of an autologous graft rather than a synthetic substitute.
Key payers included in this profile are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of where CPT code 20922 is applied clinically, typical sites of service, and the payer landscape covered in the analysis. The publication summarizes common modifiers and coding context, explains clinical scenarios that prompt use of fascia lata grafts, and outlines benchmarking and policy updates relevant to surgical graft harvesting. Data not provided in the input—such as specific associated taxonomies, ICD-10 diagnosis pairings, and detailed payer-specific reimbursement—are noted as unavailable in source material.
Billing Code Overview
CPT code 20922 describes the open harvest of a fascial graft from the fascia lata (deep fascia of the thigh). The procedure is used to obtain complex or larger sheet grafts for repair of ruptured tendons (for example, repair of an Achilles tendon), reconstruction of chest wall defects, eyelid and orbital defects, and for procedures such as unilateral gluteoplasty to treat fecal incontinence.
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Service type: Open surgical harvesting of fascia lata for grafting
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Typical site of service: Operating room or ambulatory surgery center with surgical capabilities
Clinical & Coding Specifications
Clinical Context
A 48-year-old male presents with a chronic, full-thickness rupture of the left Achilles tendon after a basketball injury that failed primary repair and now demonstrates a large tendon gap and poor local tissue quality. The orthopedic surgeon plans operative repair using a fascial graft harvested from the ipsilateral thigh fascia lata to bridge the defect and reinforce the reconstruction. Preoperative workflow includes history and physical, informed consent documenting graft harvest and donor-site risks, pre-op anesthesia clearance, surgical site marking of both the ankle and lateral thigh, perioperative antibiotics, general or regional anesthesia, and intraoperative documentation of graft dimensions and donor-site closure. Postoperative workflow includes wound care instructions for both donor and recipient sites, pain control, immobilization in a cast or boot, physical therapy referral for progressive loading once healed, and documentation of any complications such as donor-site hematoma or infection.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting only the physician’s professional portion of a service separate from technical components (rare for this surgical code). |
50 | Bilateral procedure | When fascia lata grafts are harvested bilaterally in the same operative session. |
51 | Multiple procedures | When this graft harvest is reported with other distinct procedures at the same operative session. |
52 | Reduced services | When the harvest or graft size is substantially reduced compared with usual practice. |
53 | Discontinued procedure | When the graft harvest was started but discontinued due to an unforeseen complication. |
54 | Surgical care only | When billing only for the intraoperative surgical work while another clinician bills pre/postoperative care. |
62 | Two surgeons | When two surgeons work together as primary surgeons performing separate portions of the surgery. |
66 | Surgical team (multiple surgeons) | When a surgical team approach is documented for complex composite reconstructions. |
78 | Unplanned return to OR (related) | When the patient returns to the operating room for a complication related to the original graft harvest/repair. |
79 | Unrelated procedure or service by the same physician during the postoperative period | When an unrelated surgical procedure is performed during the global period. |
59 | Distinct procedural service | When the harvest is distinct and separate from other procedures at the same session (use cautiously with supporting documentation). |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | When an advanced practice clinician assists at surgery and billing requires this modifier. |
LT | Left side | To indicate the donor or recipient side when left-sided anatomy is relevant. |
RT | Right side | To indicate the donor or recipient side when right-sided anatomy is relevant. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207X00000X | Orthopaedic Surgery | Common specialty performing tendon repair with fascia lata grafts. |
| 208800000X | Plastic and Reconstructive Surgery | Performs complex grafting for chest wall, orbital, or eyelid defects using fascia lata. |
| 2086S0122X | Colon and Rectal Surgery | Uses fascia lata in surgical treatments related to fecal incontinence and pelvic reconstruction. |
| 2080P0233X | General Surgery | May perform graft harvests for chest wall reconstruction or complex soft tissue repairs. |
| 363L00000X | Physical Medicine & Rehabilitation | Involved in postoperative rehabilitation and functional recovery planning. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
S86.011A | Strain of Achilles tendon, right leg, initial encounter | Acute or chronic Achilles tendon injuries that may require graft augmentation when primary repair is insufficient. |
S86.012A | Strain of Achilles tendon, left leg, initial encounter | As above for the left-sided tendon requiring fascia lata graft for reconstruction. |
S86.019A | Strain of Achilles tendon, unspecified leg, initial encounter | When laterality is not specified but grafting is necessary for tendon repair. |
K60.3 | Fecal incontinence (nonobstetric) | Fascia lata grafts can be used in surgical procedures addressing fecal incontinence via gluteoplasty or pelvic floor reconstruction. |
S01.81XA | Laceration without foreign body of other part of head, initial encounter | Orbital or eyelid defects from trauma that may be reconstructed using fascia lata grafts for structural support. |
S20.221A | Unspecified injury of left chest wall, initial encounter | Chest wall defects requiring fascial graft reinforcement or reconstruction. |
M66.4 | Spontaneous rupture of tendon (not elsewhere classified) | Tendon ruptures where local tissue is inadequate and fascia lata grafting is indicated. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
27370 | Repair, primary, ruptured Achilles tendon; open | Performed when primary tendon repair is attempted; fascia lata graft (20922) may be added when primary repair requires augmentation or bridging. |
15734 | Muscle, myocutaneous, or fasciocutaneous flap with microvascular anastomosis (free flap) | May be performed for larger soft-tissue defects where fascial grafts are insufficient; often part of reconstructive planning alongside graft harvest. |
13100 | Repair, complex, eyelids, nose, ears, and/or mucous membranes; 2.5 cm or less | In orbital/eyelid reconstruction where small fascial grafts (sourced via 20922) are used for structural support. |
49568 | Repair, recurrent incisional or ventral hernia, with component separation (separate procedure) | For chest wall or abdominal wall reconstructions where fascia lata grafts can be used as reinforcement in complex repairs. |
15738 | Muscle, myocutaneous, or fasciocutaneous flap, trunk or extremity; without microvascular anastomosis | May be used in conjunction with fascial grafting when additional soft-tissue coverage is required. |