Part 1: New 2020 CPT Codes | Integumentary System

Pat Maccariella‑Hafey
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.

Happy Coding!

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.