Part 4 – New 2019 CPT Codes: Lymphatic, Digestive, Urinary and Nervous System
RHIA, CDIP, CCS, CCS‑P, CIRCC
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This is Part 4 of a five part series on the new 2019 CPT codes. In this series we will explore the CPT changes for FY 2019 and include examples to help the coder understand the new codes. There is 1 new lymphatic code, 2 new digestive system codes with 3 deletions, 3 new urinary system codes with one deletion and 7 deleted nervous system codes with 2 revisions.
Lymphatic System – Biopsy of Lymph Node
One new code was created for excision of inguinofemoral lymph nodes, 38531, Biopsy or excision of lymph node(s); open, inguinofemoral node(s (For bilateral procedure, use modifier -50). These nodes are located in the groin area and are commonly removed in conjunction with other procedures. Previously, there was not a code to identify these lymph nodes.
Digestive System – Replacement of Gastrostomy Tube
Codes 41500 and 46762 were deleted due to infrequent use. Code 43760, change of gastrostomy tube, percutaneous without guidance was deleted and replaced with two new codes:
- 43762, Replacement of gastrostomy tube, percutaneous includes removal, when performed, without imaging or endoscopic guidance; not requiring revision of gastrostomy tract (includes contrast shot to confirm. This would not be considered guidance)
- 43763, requiring revision of gastrostomy tract
Code 43763 may require dilation and incision of tract due to stenosis or tract may require debridement. When does the tract have to be revised? If tube is left a long time, maceration around the tube occurs and there is inflammation, and the tract is then unusable.
Use 43762 for change of cecostomy tube as well. This was discussed at the AMA CPT Symposium in November.
Coders must be aware of the guidance used or not used to correctly assign replacement of gastrostomy tubes. For percutaneous replacement of gastrostomy tube under fluoroscopic guidance, use 49450. For endoscopically directed placement of gastrostomy tube see 43246.
Urinary System – Nephrostomy Tube
Code 50395 for dilation of tract for nephrostomy has been deleted. In its place, 2 new codes were created:
- 50436, Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological S&I, with post-procedure tube placement when performed. The enlargement of the existing tract to accommodate large instruments that will be used to perform other endourologic procedures.
- 50437, including new access into the renal collecting system (includes new access performed in the same session when a pre-existing tract is not present) (includes all elements of 50436)
(Do not report 50436, 50437 with 50080-81, 50384, 50430-34, 74485)
The coder must not confuse 50432, placement of percutaneous nephrostomy for drainage only with the new codes 50436 and 50437. Key words in the procedure report for 50432 are “access needle” “nephrostomy tube (catheter).” Key words for codes 50436 and 50437 are “balloon dilator” “serial dilators” “sheath.”
Finally new code 53854, Transurethral destruction of prostate tissue, by radiofrequency generated water vapor therapy was created and replaces old HCPCS code C9748. A video of water vapor therapy that usually treats BPH is located here: http://www.nxthera.com/convective-wave/
Nervous System – Various Codes Deleted
The AMA deleted codes 61332, 61480, 61610, 61612, 61642, 63615, 64508, 64550, mostly because these procedures are not done so much anymore. Two codes were revised as below (vascular family changed to territory)
▲ +61641, Balloon dilatation of intracranial vasospasm, percutaneous; each additional vessel in same vascular territory
▲ +61642, Balloon dilatation of intracranial vasospasm, percutaneous; each additional vessel in different vascular territory
Our final Part 5 of the series will cover miscellaneous CPT updates not covered thus far.
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.
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.
Pseudoseizures are a form of non-epileptic seizure. These are difficult to diagnose and oftentimes extremely difficult for the patient to comprehend. The term “pseudoseizures” is an older term that is still used today to describe psychogenic nonepileptic seizures (PNES).
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.
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.