Part 1: New 2021 CPT Codes | Integumentary System
RHIA, CDIP, CCS, CCS‑P, CIRCC
Executive Director Of Education
AHIMA‑Approved ICD‑10‑CM/PCS Trainer and Ambassador
This is Part 1 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes for FY2021 and include examples to help the coder understand the new codes. For 2021 in general, there were 199 new CPT codes added, 54 deleted and 69 revised.
There were no new integumentary CPT codes added however there were 2 deletions and 17 significant CPT code revisions, mostly to breast procedure codes.
Mastectomy and Breast Procedures in General
In the past, coders have had difficulty in trying to figure out the best breast procedure code for various types of revisions and for other breast procedures. They include capsulectomies, tissue expander and breast prosthesis replacements and work on the past reconstruction itself. The AMA has extensively revised the subsection notes and code descriptions to better assist coders. It is HIGHLY RECOMMENDED that all coders read the extensive revision of notes in the breast procedure subsection of CPT 19316-19396. These notes will explain why and how reconstructions are done. They also explain that each technique can stand alone, and both breasts may be reconstructed at the same time but utilizing different techniques. They also explain that 11970 describes removal and replacement of tissue expander at same time and includes minor capsule revisions. More extensive capsule revisions need to be well documented and code 19370 can then be added. The capsule is the fibrous area that surrounds the breast implant.
Across the subsection, the term “prosthesis” was replaced with “implant” to better describe that implants are used in breast surgeries. Also terms such as ‘reduction mammaplasty” were changed to just reflect “breast reduction.”
Breast Implants vs Tissue Expanders
Code “19324 – Mammaplasty, augmentation, WITHOUT prosthetic implant” has been deleted. In it’s place, coders are instructed to assign 15771 or 15772 for augmentation using fat grafting.
For 19328, Removal of intact breast implant, notes were added to tell the coder to NOT report this code for removal of a tissue expander, which is different than the actual permanent breast implant. A tissue expander is used at time of initial reconstruction to expand the remaining breast tissue enough to accept the permanent breast implant that is inserted later.
Code 19330 to was revised to “Removal of ruptured breast implant, including implant contents (e.g., saline, silicone gel. Previously this code had just stated removal of mammary implant material. The description update helps coders to understand that 19330 is for removal of a ruptured implant AND would include any material that is spilled out in the breast area. There is not a separate code reported for that. So the difference between 19328 and 19330 is whether or not the breast implant is ruptured or not. And remember, these codes are NOT for breast tissue expanders.
If a tissue expander is removed and a permanent breast implant placed, the coder is to use 11970. If the tissue expander is removed and nothing is placed back in after its removal, assign 11971.
Insertion of breast implants (not tissue expanders) codes were updated as follows:
19340 Insertion of breast implant on same day of mastectomy (i.e., immediate) (had stated immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction)
19342 Insertion or replacement of breast implant on separate day from mastectomy (had stated delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction)
These codes are now very clear as to when the insertion or replacement of the breast implant occurs. This lessens the confusion for coders. Also there are notes underneath these codes in the CPT tabular to read.
Two code descriptions were updated as follows:
19357 Tissue expander placement in breast reconstruction, including subsequent expansion(s)(previously stated breast reconstruction, immediate or delayed, including subsequent expansion) The subsequent expansions of the tissue expander is included in the code 19357.
19361 Breast reconstruction; with latissimus dorsi flap (had said the same plus “without prosthetic implant”) Read extensive notes of what not to report with this code. I there is insertion of an implant in addition to latissimus dorsi flap on same day, code 19340 in addition to 19361. If a separate day, use 19342.
Codes 19364-19369 are breast reconstruction codes using various types of flap grafts such as fTRAM, DIEP, SIEA, bi=pedicled TRAM, TRAM with and without separate microvascular anastomosis or “supercharging.” Supercharging is typically performed to increase blood flow in TRAM flaps with marginal circulation to ensure flap survival. These procedures are really the same as in 2020, the only difference in description is that they all had stated “including closure of donor site.” This is of course just part of the code. The notes before these codes explain a bit better what is done in each type of flap.
Breast Procedure Revisions
Coders previously had trouble discerning reconstruction or revision of breast reconstructions. The three main codes were revised in their descriptions as follows:
19370 Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial capsulectomy (had stated open periprosthetic capsulotomy, breast) This is usually done for displacement of the implant.
19371 Peri-implant capsulectomy, breast, complete, including removal of all intracapsular contents (had stated open periprosthetic capsulectomy, breast) The key here is COMPLETE capsulectomywith implant removal. This was added to make it clear. 19370 is used for PARTIAL capsulectomy. Physicians will need t be clear in their documentation!
(Do not report 19371 with 19328, 19330, or 19370 in the same breast. For removal and replacement with new implant, use 19342)
19380 Revision of reconstructed breast (eg, significant removal of tissue, re-advancement and/or re-inset of flaps in autologous reconstruction or significant capsular revision combined with soft tissue excision in implant- based reconstruction (had stated revision of reconstructed breast). This code description is probably the code description most extensively revised. A full listing of codes not to report this with is in the CPT tabular so coders must reference those notes.
Documentation is very important in all of the breast procedure codes. Facilities may want to meet with their surgeons to review the changes above so that documentation needed for coders is included in operative reports.
We advise coders to utilize our Breast Reconstruction in CPT Action Plan and also to view photos online of the various techniques used in breast reconstruction. Sometimes seeing these visually helps to better understand what is being done.
The only other code addition for integument was:
0598T Noncontact real-time fluorescence wound imaging, for bacterial presence, location, and load, per session; first anatomic site (eg, lower extremity)
+0599T each additional anatomic site (eg, upper extremity)
The use of real time fluorescence wound imaging assists the provider in diagnosing the dept of a wound and the bacterial load. A hand held device “sees through” the wound using fluorescence technology.
In Part 2, we will discuss musculoskeletal and respiratory CPT code changes.
The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
This is Part 5 of a five part series on the new 2021 CPT codes. For the remaining areas we will just briefly summarize the section. Due to the intricate nature of these sections in CPT, it is recommended that the coder read the entire section notes associated with the new codes.
This is Part 4 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes in the urinary, nervous, ocular and auditory systems. There are 2 new urinary/male reproductive system codes with no revisions or deletions; 3 new female reproductive codes with 2 deletions, 0 new with 4 deleted nervous system codes with 5 revisions; 5 new eye category III codes; and finally a 2 new auditory codes with one deletion.
This is Part 3 of a five part series on the new 2021 CPT codes. In this series we will explore the cardiovascular system CPT changes. There are 5 new cardiovascular CPT codes added with 0 deletions and 4 revisions.
This is Part 2 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes for FY2021 and include some examples to help the coder understand the new codes. There are 0 new musculoskeletal CPT codes added with 0 deletions and 2 major revisions along with an extensive update to arthroscopic loose body removal requirements. For the respiratory system, there were 2 new codes, one code deletion and no revisions.
In January, new CPT codes were released. There were 248 new CPT codes added, 71 deleted and 75 revised. Most of the surgery section changes were in the musculoskeletal and cardiovascular subsections. These included procedures such as skin grafting, breast biopsies, deep drug delivery systems, tricuspid valve repairs, aortic grafts and repair of iliac artery.
We have seen many updates and changes to COVID-19 (SARS-CoV-2) since the pandemic started. On January 1, 2021 we will see even more changes as outlined in this post. Also the CMS MS-DRG grouper will be updated to version 38.1 to accommodate the changes.
In the previous three parts of this four-part series, we discussed the new ICD-10-CM diagnosis code changes, ICD-10-PCS procedure code changes and FY2021 IPPS changes. In this last Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments for FY2021.
In the previous two parts of this four part series, we discussed the new ICD-10-CM diagnosis code changes and ICD-10-PC procedure code changes. In this session we will review the major IPPS changes for FY2021.
This is Part 2 of a 4 part series on the FY2021 ICD-10 Code and IPPS changes. In this part, the ICD-10-PCS procedure codes are presented. For FY2021 ICD-10-PCS there are 78,115 total codes (FY2020 total was 77,571); 556 new codes (734 new last year in FY2020)…
This is Part 1 of a 4 part series on the FY2021 changes to ICD-10 and the IPPS. In this part, we discuss some of the new ICD-10-CM diagnosis changes. Here is the breakdown: 72,616 total ICD-10-CM codes for FY2021; 490 new codes (2020 had 273 new codes); 58 deleted codes (2020 had 21 deleted codes); 47 revised codes (2020 had 30 revised codes)
Acute pulmonary edema is the rapid accumulation of fluid within the tissue and space around the air sacs of the lung (lung interstitium). When this fluid collects in the air sacs in the lungs it is difficult to breathe. Acute pulmonary edema occurs suddenly and is life threatening.
“Client S” is a small, not-for-profit, 40 bed micro-hospital in the Southeast. HIA performed a 65-record review this year for Client S and found an opportunity with 15 of them. 9 had an increased reimbursement with a total of $43,228 found.
The coma scale codes (R40.2-) can be used in conjunction with traumatic brain injury codes, acute cerebrovascular disease or sequelae of cerebrovascular disease codes. These codes are primarily for use by trauma registries, but they may be used in any setting where this information is collected. The coma scale may also be used to assess the status of the central nervous system for other non-trauma conditions, such as monitoring patients in the intensive care unit regardless of medical condition.
In the past, there had been an Excludes1 note at I46.- Cardiac arrest that excluded R57.0, Cardiac shock. HIA had also received a letter from AHA on a case in the past that had stated that only I46.- Cardiac arrest would be coded if both were documented. In addition, the Third Quarter Coding Clinic page 26 had a similar case that asked if both could be coded, and AHA had instructed that only I46.9, cardiac arrest, cause unspecified would be coded if both were documented and that the CDC would be looking at possible revision to the Excludes1 note.
A higher CMI corresponds to increased consumption of resources and increased cost of patient care, resulting in increased reimbursement to the facility from government and private payers, like CMS. We know that documentation directly impacts coding.
Lately we have seen several cases where the endarterectomy was assigned along with the coronary artery bypass (CABG) procedure when being performed on the same vessel to facilitate the CABG. A coronary artery endarterectomy is not always performed during a CABG procedure, so when it is performed it becomes confusing as to whether to code it separately or not.
Assign code Z20.828, “Contact with and (suspected) exposure to other viral communicable diseases” for all patients who are tested for COVID-19 and the results are negative, regardless of symptoms, no symptoms, exposure or not as we are in a pandemic.
The Centers for Medicare & Medicaid Services (CMS) announced new procedure codes for treatments of COVID-19 – effective as of August 1, 2020. Among the new codes are Section X New Technology codes for the introduction or infusion of therapeutics including Remdesivir, Sarilumab, Tocilizumab, transfusion of convalescent plasma, as well as introduction of any other or new therapeutic substances for the treatment of COVID-19.
One common element in many value-based programs is risk adjustment using Hierarchical Condition Categories (HCCs) to create a Risk Adjustment Factor (RAF) score. This method ranks diagnoses into categories that represent conditions with similar cost patterns.
Why are so many AKI records being denied? It’s hard to give one answer for why so many AKI records are being denied lately, but most appear to be due to the multiple sets of criteria available for use in determining if a patient has AKI, as well as physician documentation. As stated in Part 3 of this series, there are three main criteria/classifications used to diagnose AKI.
In previous parts of this series we looked at the definitions of AKI/ARF, causes, coding and sequencing, and the common clinical indicators that patients present with that are diagnosed with this condition. In Part 4, we will look at the documentation that should be present to report the diagnosis without fear of denial, as well as when a query is needed to clarify the diagnosis.
If the facility does a COVID-19 test, and test is negative, do I need a diagnosis code. The answer is yes, you will report a Z-code. The Z-code depends on the record documentation and circumstances of testing. For any patient receiving a COVID-19 test, if negative, there MUST e a Z-code to describe why the test was taken. (Test negative for COVID-19 and MD does not override negative results).
In the first parts of this series we looked at definitions of AKI/ARF, causes, coding and sequencing. In Part 3, we will look at what clinical indicators would possibly be present to support the diagnosis of AKI/ARF.
As discussed in Part 1 of this series, AKI/ARF is a common diagnosis that coders see daily. In Part 2, we are going to focus on the different types/specificity of AKI/ARF. We’ll learn what they mean, as well as how to code the diagnosis.
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With the proliferation of COVID-19 cases, we thought we would put together a quick reference listing of some of the common scenarios that coders have asked about. As with all coding, coders should follow Official Guidelines for Coding and Reporting and the COVD-19 Frequently Asked Questions document by the AHA.
Effective March 1, Medicare will pay physicians for telehealth services at the same rate as in-person visits for all diagnoses, not just services related to COVID-19. This great for providers whose patients are reluctant to visit the office.
The biggest reasons why some hospital systems are moving to single path coding is to eliminate duplicative processes and to optimize productivity. In addition, costs are reduced when only one coder “touches” the record and completes both types of coding.
Effective with 4/1/2020 discharges, ICD-10-CM code U07.0 is used to report vaping -related disorders. ICD-10-CM code U07.0 (vaping related disorder) should be used when documentation supports that the patient has a lung-related disorder from vaping. This code is found in the new ICD-10-CM Chapter 22. U07.0 will be in listed in the ICD-10-CM manual under a new section: Provisional assignment of new disease of uncertain etiology or emergency use.