Part 4: New 2021 CPT Codes | Urinary, Nervous, Ocular and Auditory Systems
RHIA, CDIP, CCS, CCS‑P, CIRCC
Executive Director Of Education
AHIMA‑Approved ICD‑10‑CM/PCS Trainer and Ambassador
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.
Urinary/Male Reproductive System – Prostate Commissurotomy and HIFU Prostate Ablation
Although there were no new urinary codes, there was an update and are two new codes that address prostate procedures.
▲ 50690 Injection procedure for visualization of ileal conduit and/or ureteropyelography, exclusive of radiologic service
(For radiological S&I see 74420 for retrograde or 74425 for antegrade injection)
The note under the code was updated note to differentiate between retrograde and antegrade S&I.
- 0619T Cystourethroscopy with transurethral anterior prostate commissurotomy and drug delivery, including transrectal ultrasound and fluoroscopy, when performed.
In this procedure, the surgeon performs division of the anterior prostatic commissure and the bladder neck (but sparing the mucosa) to achieve “urethral decompression”. This simple technique is performed for the treatment of benign prostatic hypertrophy. This new code depicts a cystoscopy and transurethral approach to the procedure. There are extensive “Do not report” notes with this code.
- 55880 Ablation of malignant prostate tissue, transrectal, with high intensity-focused ultrasound (HIFU), including ultrasound guidance is a new code for treating prostate cancer. HIFU uses sound waves that a doctor points through the wall of the rectum. They’ll direct the waves at the cancer cells. The sound waves heat up to temperatures as high as 90 C (194 F) and can kill cancer cells in just a few seconds. Doctors use magnetic resonance imaging (MRI) and ultrasound imaging to find out exactly where the tumor is and where to point the sound waves. It takes 1-4 hours to perform.
Female Reproductive Systems – Computer Mapping with Colposcopy
There is a new add on code +57465 Computer-aided mapping of cervix uteri during colposcopy, including optical dynamic spectral imaging and algorithmic quantification of the acetowhitening effect (list separately in addition to code for primary procedure)
This procedure is usually reported with procedures 57420-57421, 57452-57461 for various colposcopic procedures. The acetic acid (vinegar) washes away mucus and allows abnormal areas to be seen more easily with the colposcope. … The areas that stain white after the acetic acid wash are called “acetowhite lesions.”
Codes 57112 for vaginectomy with removal of paravaginal tissue and 58293 for vaginal hysterectomy – Marshall-Marchetti-Granz type or Pereyra type were deleted as they are no longer used.
Two new codes were created for temporary intraurethral valve-pump that treats stress incontinence. The patient has an inflow device inserted which resides in situ in the urethra. The patient then uses a remote control device that activates the small magnetic pump in the urethra that allows voiding.
- 0596T Temporary female intraurethral valve-pump (ie, voiding prosthesis); initial insertion, including urethral measurement
- 0597T Replacement
(Do not report with 51610, 51700-51705 which are the insertion of bladder catheter codes)
Nervous System – Updated Spinal Injection Codes
Spinal puncture codes were updated to make them non-parent codes to parent code 64400. This rectifies an error in last year’s CPT book.
▲64455 plantar common digital nerve(s) (eg, Morton’s neuroma)
▲64479 transforaminal epidural, with imaging guidance (fluoroscopy or CT), cervical or thoracic, single level
▲+64480 transforaminal epidural, with imaging guidance (fluoroscopy or CT), cervical or thoracic, each additional level
▲64483 transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, single level
▲+64484 transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, each additional level
Craniectomy codes 61870 and 62163 along with laminectomy codes 63180 and 63182 have been deleted due to low utilization of these codes.
Ocular and Auditory Systems
New and revised codes were added as follows:
- 0616T – Insertion of iris prosthesis, including suture fixation and repair of removal of iris, when performed; without removal of crystalline lens or intraocular lens, without insertion of intraocular lens
- 0617T – with removal of crystalline lens and insertion of intraocular lens
- 0618T – with secondary intraocular lens placement or intraocular lens exchange
This is a procedure that addresses the replacement of the iris with a prosthesis. This is done in patients with aniridia, which is absence of the iris and traumatic injury to the iris.
- 0621T – Trabeculostomy ab interno by laser
- 0622T – with use of ophthalmic endoscope
Excimer Laser Trabeculostomy (ELT) is one example. This procedure creates ten openings in the trabecular meshwork and inner wall of Schlemm’s canal. Ab interno means to DECREASE intraocular pressure by increasing aqueous outflow through an opening in the trabecular meshwork.
For the auditory system, two new codes were created:
- 69705 Nasopharyngoscopy, surgical, with dilation of eustachian tube (i.e, balloon dilation) unilateral
- 69706 bilateral
(Do not report 69705, 69706 in conjunction with 31231, nasal endoscopy)
There is now a code for the nasopharyngoscopy approach to dilate the eustachian tube. Balloon dilation
of the Eustachian tubes is an endoscopic procedure that usually approaches the Eustachian tubes
nasally, and using a balloon catheter, expands and stretches the Eustachian tube. It is proposed to
relieve chronic ear congestion and middle ear and mastoid infections.
Our final Part 5 of the series will cover miscellaneous CPT updates not covered thus far such as
Evaluation and Management and some Category III codes not previously discussed.
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.
Wow, have you seen the proposed rule for FY2023 IPPS yet? There are 1,495 proposed coding changes to ICD-10-CM diagnoses codes alone! There are also some IPPS changes to note. As for ICD-10-PCS, there are not as many new codes, most significantly occlusion of prostate artery and knee joint replacement codes.
Coding denials are sent after the auditor has reviewed the record in question and the auditor does not agree with the DRG that was paid. This can be for either a diagnosis or a procedure code that they think does not meet reporting requirements.
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As of April 1, 2022 discharges, the following changes in ICD-10 and IPPS will be implemented. For years the coding community did not see changes occurring in April of the fiscal year. HIM professionals were used to not even worrying about April changes. This year, we do have some significant code additions and a change in the IPPS CC/MCC edit. The ICD10MCE and Grouper Version will be 39.1.
DRG 640 (Miscellaneous disorders of nutrition, metabolism, fluids, and electrolytes with MCC) was the number 9 most common DRG with recommendations from HIA in 2021.
DRG 981 (Extensive O.R Procedures unrelated to principal diagnosis with MCC) was the number 8 most common DRG with recommendations from HIA in 2021.
DRG 291 (Heart failure with shock with MCC). This should be no surprise to coders that DRG 291 is in the top DRG’s with recommendation. It seems to always be in the top 5 and a focus for denials.
DRG 177 (Respiratory infections and inflammations with MCC) and 178 (Respiratory infections and inflammations with CC). This should be no surprise to coders that DRG 177 is in the top DRG’s with recommendation.
Sepsis is and will most likely always be a troubled area for coders. There are multiple reasons for this and we will look at a few of these. There are many different criteria being used to validate the diagnosis of sepsis.
During a recent review of spinal fusion cases at a client, we found coding issues on the cases in which both an anterior interbody fusion, anterior open approach was done on one day and two days later, the patient was brought back for a posterior fusion, posterior open approach. Below are some of the recommendations we made along with education explanations.
This is Part 5 of a five part series on the new 2022 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 5 part series on the new 2022 CPT codes. In this one we will explore the nervous, ocular and auditory systems CPT changes.
This is Part 3 of a 5 part series on the new 2022 CPT codes. In this one we will explore the digestive, urinary and reproductive system CPT changes.
This is Part 1 of a five part series on the new 2022 CPT codes. In this series we include examples to help the coder understand the new codes.
10 ICD-10 Codes from the Christmas movie Home Alone. T20. 10XA for Harry, Burn of first degree of head, face, and neck, unspecified site, initial encounter. T20.56XA for Kevin and his aftershave incident, Corrosion of first degree of forehead and cheek, initial encounter.
Did you get a chance to read the FY2022 IPPS Final Rule? There is an interesting topic that was discussed regarding unspecified ICD-10-CM laterality diagnosis codes, to be exact. In this coding tip we discuss that subject and possible ramifications of it in the coding world.
In Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments. Prepare yourself as this is rather lengthy due to continuation of NTAP that would normally expire.
Coders are instructed, at this time, to follow the AHA Frequently Asked Questions Regarding ICD-10-CM/PCS Coding for COVID-19. Lately, we have seen missing PCS codes for the new technology drugs that were introduced on August 1, 2020 and thereafter.