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.
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.
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.
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.