Part 1: New 2022 CPT Codes – Integumentary, Musculoskeletal Systems
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 2022 CPT codes. In this series we will explore the CPT changes for CY2022 and include examples to help the coder understand the new codes. For 2022 in general, there were 249 new CPT codes added, 63 deleted and 93 revised.
In this series we will also include category III procedures as they pertain to the body system procedures discussed. Although they are not located in the surgery section, many of the category III additions involve surgical procedures.
There was only one code revision, and that was for code 11981, Insertion Drug-Delivery implant (i.e., bioresorbable, biodegradable, non-biodegradeable). The bolded terms were added to make the code more accurate. If a biodegradable or bioresorbable implant is removed, use 17999.
New category III code 0658T, Electrical impedance spectroscopy (EIS) of 1 or more skin lesions for automated melanoma risk score was added. The EIS device consists of a handheld probe with a disposable electrode that is applied directly on the skin and uses electrical impendence differences to differentiate between normal and abnormal skin lesions. The EIS algorithm is best used on lesions that are deemed clinically suspicious and has a high sensitivity in detecting malignant melanoma.
The remainder of updates in this sub-section are for the descriptions under “Repair and/or Reconstruction.” Basically the AMA made the descriptions read more clearly, but did not change the actual intent. They added “chemical cauterization” and “electrocauterization” as types of wound closures that should be coded with the appropriate E/M code.
Also they added “Hemostasis and local or topical anesthesia, when performed, are not reported separately” under simple repair.
Overall Introduction notes updated (re-iterated at cast/strapping subsection):
- All services in this chapter include application and removal of FIRST cast, splint or traction device. Supplies reported separately. If cast is removed by someone other than professional who put it on, the provider taking it off reports the removal code, 29070, 29705, 29710.
- Subsequent replacement of case, splint or strapping 29000-29750 or traction 20690-20692 during or after the global period may be reported separately.
Notations were added and updated such as: There is no correlation between the type of fx/dislocation
(open, closed) and the type of treatment (open, closed, percutaneous). The types of treatment definitions
have been reworded and expanded. Explanation of when to use modifier -54 Surgical Care Only was added.
Closed treatment of nasal bone fracture code 21215 was amended to read “with manipulation” and either
without stabilization or with stabilization (21320). Closed treatment is coded to the E/M code.
Definitions for corpectomy, facetectomy, foraminotomy, hemilaminectomy, lamina, laminectomy, laminotomy have been added to this subsection. It is very important that the coder read these in detail.
Visual definitions of spinal anatomy and procedures were added as well which is a HUGE help for coders in understanding what these spinal procedures involve. The photos include laminectomy, approaches and such. Here is one example:
►Corpectomy: Identifies removal of a vertebral body during spinal surgery.◄
These are different than interbody arthrodesis. In corpectomy, rarely is total vertebra removed. The corpectomy as to be greater than 50% cervical, or 33% or greater on thoracic and lumbar. MD will need to document this! If less than 33% or 50%, technically does not mean corpectomy. Review the images in CPT book along with descriptions.
Added: Decompression performed on the same vertebral segment(s) and/or interspace(s) as posterior lumbar interbody fusion that includes laminectomy, facetectomy, and/or foraminotomy MAY BE separately reported using 63052, 63053 (New codes created for decompression during posterior interbody arthrodesis) More on that when we discuss neurology changes.
Decompression SOLELY to prepare the interspace for fusion is NOT separately reported. The notes were updated on arthrodesis codes to reflect this fact.
Codes 22600-22614 for arthrodesis, posterior or posterolateral technique, replaced the term “level” with “interspace” to be consistent within the chapter. Coders can get confused with terms such as “level,” “segment,” and “interspace.” Look at page 164 in the CPT Professional book for an excellent photo that depicts the “segment” vs “interspace.” Vertebral level examples would be level C3, level T2, or level L4. A vertebral segment describes the basic constituent part into which the spine may be divided. It represents a single complete vertebral bone with its associated articular processes and laminae. A vertebral interspace is the nonbony compartment between two adjacent vertebral bodies which contains the intervertebral disc and includes the nucleus pulposus, annulus fibrosus, and two cartilaginous endplates.
Two codes, 0656y and 0657T were added for vertebral body tethering either up to 7 segments or 8 or more. This is different than fusion and the rods and screws are placed on the side of the vertebra, to allow movement, unlike fusion in which flexible cord and anchors are placed in the back, with bone graft, and do NOT allow movement.
In Part 2, we will discuss cardiovascular CPT code changes.
The information contained in this post 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.
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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.
Clinical trials are research studies performed in people that are aimed at evaluating a medical, surgical, or behavioral intervention. They are the primary way that researchers find out if a new treatment, like a new drug or diet or medical device (for example, a pacemaker) is safe and effective in people.
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.
With the creation and implementation of ICD-10-CM, multiple codes are available to describe the type of pulmonary emboli that occur.
Hypercoagulable states are blood disorders that increase the risk of deep vein thrombosis or embolic disease. The state is either inherited or acquired. About 80% of patients with blood clots have been found to have either an inherited or acquired clotting disorder. These blood clots can be lethal and some require life-long therapy. Hypercoagulable state is also known as thrombophilia.
Encephalopathy is a general term and means brain disease, brain damage or malfunction. Physicians often use encephalopathy and altered mental status interchangeably. When coders see this documentation in the healthcare records, they typically need to query the physician for clarification of the diagnosis.
Spinal procedure coding can be daunting for coders. The spine itself can be quite complicated anatomically and the procedures done to address spinal conditions can be even more complicated!
In June CMS released the final ICD-10-PCS codes for FY2022, which begins October 1, 2021. We are giving you a sneak peek at the changes. HIA will have a full educational module on these changes available later this summer.
CMS released the IPPS proposed rule on 4/27/21 outlining the proposed changes to the Inpatient Prospective Payment System for FY2022, which begins October 1, 2021. Later this year, sometime in August, CMS will release the Final Rule. Currently CMS is reviewing responses to their proposed rule and will address them in the final rule.
A medical coding audit is a process that includes internal or external reviews of medical coding and billing accuracy, procedures or policies in place, and any other component that affects the medical record documentation. Medical coding audits…
Anticoagulants and antiplatelets are used for the prevention and treatment of blood clots that occur in blood vessels. Oftentimes, anticoagulants and antiplatelets are referred to as “blood thinners,” but they don’t actually thin the blood at all. These drugs slow down the body’s process of making clots. Their main function is to keep the patient’s blood from clotting or turning into solid clumps of cells. These drugs do this by interfering with either fibrin or platelets in the blood.
Carotid artery disease is a vague category that can incorporate many different carotid artery issues. Some physicians may feel that they are being clear the patient has plaque, stenosis, or occlusion of the artery, but in ICD-10-CM the specificity must be included in the documentation.
10 ICD-10 Codes for Superheroes. Superman: T78.2XXA Anaphylactic reaction; substance: kryptonite. Batman: F44.81 Dissociative identity disorder. Robin: F60.7 dependent personality. The Hulk: L30.4 Erythema intertrigo. Wonder Woman: T24.032A Burn of unspecified degree of left lower leg. Black Panther S93.401A Sprain…
Practices have not seen many revisions to the Evaluation and Management (E/M) office / outpatient visit guidelines in three decades – until now. As of January 1, there are new E/M coding guidelines. We’ll get to those in a bit, but first let’s look at why they changed.
With the implementation of ICD-10-CM came different codes and coding rules for many diagnoses. One of these is the coding of bowel obstruction when the patient presents for this condition that is caused by another condition.
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.
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.