Part 1: New 2020 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 2020 CPT codes. In this series we will explore the CPT changes for FY2020 and include examples to help the coder understand the new codes. For 2020 in general, there were 248 new CPT codes added, 71 deleted and 75 revised.
There were 5 new integumentary CPT codes added with 4 deletions and 1 revision.
Revision to Descriptions of Intermediate vs Complex Repair
In the past, coders had a difficult time discerning what “extensive” undermining meant in complex repairs. There was not a clear definition. To remedy this, the AMA has now defined two new terms, “limited” undermining and “extensive” undermining.
A new photo in the CPT book page 89 defines and helps to show the differences between limited undermining extensive undermining:
Intermediate repair includes LIMITED undermining defined as a distance LESS THAN the maximum width of the defect, measured perpendicular to the closure line.
Complex repair includes EXTENSIVE undermining defined as a distance EQUAL TO or GREATER THAN the maximum width of the defect, measured perpendicular to the closure line.
Be sure to view the photo in the CPT book for better understanding.
Surgeon education on documentation requirements will be needed so be sure your CDI department is aware of this change.
Grafting by Harvesting
There are new codes for the type and method of autologous tissue grafting. Code 20926 tissue grafts, other has been deleted. Note that the below codes differentiate between directly excised soft tissue, and autologous fat taken by liposuction. Add on codes are for additional amounts taken by liposuction so the surgeon must be sure to document the number of cc’s harvested.
- # 15769 Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis fascia) (For injections of platelet-rich plasma use 0232T)
- 15771 Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs, 50 cc or less injectate (Report 15771 only once per session)
- +15772 each additional 50 cc injectate or part thereof (list in addition to primary)
- 15773 Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits genitalia, hands, and/or feet, 25 cc or less injectate (Report 15771 only once per session)
- +15774 each additional 25 cc injectate or part thereof (list in addition to primary) (Use 15774 in conjunction with 15773)
Percutaneous Breast Biopsies
New notes and explanations are at the beginning of subsection starting at cod 19081. The AMA did expand the notes to better define when to use a PRIMARY biopsy code and when to use an add on code depending on the type of imaging.
- A fine needle aspiration (FNA) biopsy is performed when material is aspirated with a fine needle and the cells are examined cytologically.
- A CORE needle biopsy is typically performed with a larger bore needle to obtain a core sample of tissue for histopathologic evaluation.
- Basically the new notes break out each type of biopsy and state that percutaneous image-guided breast biopsies including breast localization devices include the imaging which is not reported separately.
When more than one perc biopsy using same imaging guidance, use add on code even if on opposite breast. (Same as last year)
If more than one perc biopsy done using DIFFERENT imaging guidance, use another PRIMARY biopsy code with the new imaging (not the add on code) (Same as last year)
For bilateral image guided biopsies, report primary code for first biopsy and the ADD ON CODE for each contralateral biopsy or additional biopsy. (Not -50, -59) (like last year)
Mastectomy and Breast Procedures
Notes were added to describe partial mastectomy, total mastectomy, and radical mastectomy. This had been a confusing area for coders, so the AMA has added the descriptions before code 19300. Previously there had not been any descriptions.
New category III code 0546T – Radiofrequency spectroscopy real time at partial mastectomy with report was added. 0546T is used to identify any remaining cancerous tissue at margins at time of partial mastectomy. It is reported once per surgery.
Code 19304 for subcutaneous mastectomy has been deleted. To report breast reduction or tissue removal for gynecomastia, see 19300, mastectomy for gynecomastia. For breast tissue removal for breast-size reduction for other than gynecomastia, use 19318, reduction mammoplasty.
New category III code 0581T – Ablation, malignant breast tumor(s), percutaneous, cryotherapy, including imaging guidance when performed, unilateral has been added. Cryoablation involves two “freeze/thaw” cycles to completely ablate tumor. Code 0581T is reported once per surgery even if several rounds of cryoablation are done. The code includes imaging.
Throughout CPT, notes have been added to NOT report modifier =50 on addon condes. For example, under code +15777 for Implantation of biologic implant, the new note states: “For bilateral breast procedure, report 15777 twice. Do not report modifier 50 in conjunction with 15777.”
In Part 2, we will discuss musculoskeletal 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.
The Circulatory chapter is one that is identified every year as having a large number of coding changes. Many of these changes are related to documentation providing more specificity and, in some cases, less specificity than the codes reported. Below we will discuss some of the areas of opportunity in this chapter.
In 2019, we reviewed over 50,000 diagnosis codes from many different specialties for our Professional Fee clients. Here are the top three ICD-10-CM chapters where HIA identified coding opportunities: Z00-Z99 – Factors influencing health status and contact with health services; I00-I99 – Circulatory system and; R00-R99 – Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified.
This is Part 5 of a five part series on the new 2020 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 2020 CPT codes. In this series we will explore the CPT changes for FY 2020 and include examples to help the coder understand the new codes. There is 3 new digestive system codes with 1 deletion and 2 revised; 1 revised urinary system codes with new category III codes; 6 new with 20 deleted nervous system codes with 3 revisions; 2 new eye codes with 3 revisions; and finally a new category III auditory code.
This is Part 3 of a five part series on the new 2020 CPT codes. In this series we will explore the CPT changes for FY2019 and include examples to help the coder understand the new codes. There are 11 new cardiovascular CPT codes added with 8 deletions and 2 revisions.
This is Part 2 of a five part series on the new 2020 CPT codes. In this series we will explore the CPT changes for FY2020 and include some examples to help the coder understand the new codes. There are 11 new musculoskeletal CPT codes added with 1 deletion and 0 revisions.
This is Part 6 of a 6-part series focusing on CPT coding of breast procedures. There are many different types of breast reconstruction procedures, each having potential stumbling-blocks for coders. Part 6 focuses on revision of a reconstructed breast.
This is Part 5 of a 6-part series focusing on CPT coding of breast procedures. There are many different types of breast procedures, each having potential stumbling-blocks for coders. This series will address several of the more confusing topics. Part 5 focuses on the coding of different types of autologous tissue breast reconstruction procedures.
Part 4: CPT Breast Education Series | Use of Acellular Dermal Matrix with Breast Implant Reconstruction
This is Part 4 of a 6-part series focusing on CPT coding of reconstructive procedures following mastectomy. There are many different types of breast reconstruction procedures, each having potential stumbling-blocks for coders. Part 4 focuses on the use of acellular dermal matrix with breast implant reconstruction.
Part 3: CPT Breast Education Series | Immediate Versus Delayed Permanent Breast Implant Reconstruction
This is Part 3 of a 6-part series focusing on CPT coding of breast procedures. There are many different types of breast procedures, each having potential stumbling-blocks for coders. This series will address several of the more confusing topics. Part 3 focuses on the difference between immediate and delayed permanent breast implant reconstruction.
This is Part 2 of a 6-part series focusing on CPT coding of breast procedures. There are many different types of breast reconstruction procedures, each having potential stumbling-blocks for coders. This series will address several of the more confusing topics. Part 2 focuses on the use of tissue expanders in breast reconstruction.
With the implementation of ICD-10-PCS the description of codes became much more detailed to describe exactly what is being performed. Cardiac catheterization is one of the descriptions that changed to further detail exactly what is being performed during the procedure.
This is Part 1 of a 6-part series focusing on CPT coding of reconstructive procedures following mastectomy. There are many different types of breast reconstruction procedures, each having potential stumbling-blocks for coders. Part 1 is an overview of the types of breast reconstruction techniques commonly used. Future topics in this series will go into more detail of each technique and the CPT coding implications.
With Christmas fast-approaching, we’re making a list of our favorite holiday movies and checking it twice. And in the spirit of good humor and cheer, we’ve added some ICD-10 codes to these holiday classics. Have a safe, happy, and healthy holiday everyone!
“Lobar” pneumonia references a form of pneumonia that affects a specific lobe or lobes of the lung. This is a bacterial pneumonia and is most commonly community acquired. Antibiotics are almost always necessary to clear this type of pneumonia.
Why are so many sepsis records denied? It’s hard to say why there seem to be so many sepsis denials of late, but most likely this is due to the multiple sets of criteria for the diagnosis of sepsis, change in definition of sepsis, as well as physician documentation.
In Parts 1, 2 and 3 we learned about what sepsis is, sequencing of sepsis and what documentation is needed to report severe sepsis. In Part 4, we will look at clinical indicators needed to clinically support the diagnosis of sepsis and determine if a query is indicated.
Severe sepsis occurs when sepsis progresses and signs of organ dysfunction/failure develop. One site stated that approximately 30% of patients with severe sepsis do not survive. Patients may develop one organ dysfunction/failure, multi-system organ failure and/or septic shock.
In Part 2 of our Sepsis Series, we are going to focus on sequencing of sepsis when the diagnosis is clearly documented. Later in the series we will look at what to do when the diagnosis is not clearly documented.
In this series, we will learn what sepsis is or causes of sepsis, how to sequence the diagnosis in ICD-10-CM, what are the clinical indicators for sepsis, is a query necessary before reporting the diagnosis of sepsis, and how to prevent denials on sepsis records.
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 FY2020 IPPS changes. In this last Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments for FY2020.
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 FY2020. On August 2, 2019, CMS published the Final Rule for IPPS (CMS-1716) FY2020 IPPS Final Rule.
In Part 1 of this 4 part series we discussed some of the new ICD-10-CM diagnosis changes. In Part 2 we present the significant ICD-10-PCS procedure code changes. There are 72,184 total ICD-10-CM codes for FY2020.
We have finished with the step-by-step coding tidbits on coding of spinal fusions. If you were not able to catch Parts 1-13 of this series focused on spinal fusions, please visit hiacode.com/topics/series/spinal-fusion-coding/.
In Part 12, we focused on intra-operative peripheral neuro monitoring used during spinal fusion surgery. In Part 13, we are going to focus on harvesting of autograft and is it coded. Remember in Part 6, we learned that autograft is bone from the patient.
In Part 11, we focused on identifying the computer assisted navigation used during spinal fusion surgery. In Part 12, we are going to focus on intra-operative peripheral neuro monitoring.
In Part 10, we focused on identifying whether or not hardware from a previous spinal fusion is coded. In Part 11, we are going to discuss computer assisted navigation.
In Part 9, we focused on identifying if decompression was also performed and if so, on which body part. In Part 10, we are going to focus on identifying if hardware was removed from a previous fusion site.
In Part 8, we focused on identifying if a discectomy was performed, and if so, if it was a partial or a total discectomy. In Part 9, we are going to focus on identifying if a decompression was performed, and if so, was it of the spinal cord, spinal nerves or both?