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.
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.
“Client S” is a small, not-for-profit, 40 bed micro-hospital in the Southeast. HIA performed a 65-record review this year for Client S and found an opportunity with 15 of them. 9 had an increased reimbursement with a total of $43,228 found.
The coma scale codes (R40.2-) can be used in conjunction with traumatic brain injury codes, acute cerebrovascular disease or sequelae of cerebrovascular disease codes. These codes are primarily for use by trauma registries, but they may be used in any setting where this information is collected. The coma scale may also be used to assess the status of the central nervous system for other non-trauma conditions, such as monitoring patients in the intensive care unit regardless of medical condition.
In the past, there had been an Excludes1 note at I46.- Cardiac arrest that excluded R57.0, Cardiac shock. HIA had also received a letter from AHA on a case in the past that had stated that only I46.- Cardiac arrest would be coded if both were documented. In addition, the Third Quarter Coding Clinic page 26 had a similar case that asked if both could be coded, and AHA had instructed that only I46.9, cardiac arrest, cause unspecified would be coded if both were documented and that the CDC would be looking at possible revision to the Excludes1 note.
A higher CMI corresponds to increased consumption of resources and increased cost of patient care, resulting in increased reimbursement to the facility from government and private payers, like CMS. We know that documentation directly impacts coding.
Lately we have seen several cases where the endarterectomy was assigned along with the coronary artery bypass (CABG) procedure when being performed on the same vessel to facilitate the CABG. A coronary artery endarterectomy is not always performed during a CABG procedure, so when it is performed it becomes confusing as to whether to code it separately or not.
Assign code Z20.828, “Contact with and (suspected) exposure to other viral communicable diseases” for all patients who are tested for COVID-19 and the results are negative, regardless of symptoms, no symptoms, exposure or not as we are in a pandemic.
The Centers for Medicare & Medicaid Services (CMS) announced new procedure codes for treatments of COVID-19 – effective as of August 1, 2020. Among the new codes are Section X New Technology codes for the introduction or infusion of therapeutics including Remdesivir, Sarilumab, Tocilizumab, transfusion of convalescent plasma, as well as introduction of any other or new therapeutic substances for the treatment of COVID-19.
One common element in many value-based programs is risk adjustment using Hierarchical Condition Categories (HCCs) to create a Risk Adjustment Factor (RAF) score. This method ranks diagnoses into categories that represent conditions with similar cost patterns.
Why are so many AKI records being denied? It’s hard to give one answer for why so many AKI records are being denied lately, but most appear to be due to the multiple sets of criteria available for use in determining if a patient has AKI, as well as physician documentation. As stated in Part 3 of this series, there are three main criteria/classifications used to diagnose AKI.
In previous parts of this series we looked at the definitions of AKI/ARF, causes, coding and sequencing, and the common clinical indicators that patients present with that are diagnosed with this condition. In Part 4, we will look at the documentation that should be present to report the diagnosis without fear of denial, as well as when a query is needed to clarify the diagnosis.
If the facility does a COVID-19 test, and test is negative, do I need a diagnosis code. The answer is yes, you will report a Z-code. The Z-code depends on the record documentation and circumstances of testing. For any patient receiving a COVID-19 test, if negative, there MUST e a Z-code to describe why the test was taken. (Test negative for COVID-19 and MD does not override negative results).
In the first parts of this series we looked at definitions of AKI/ARF, causes, coding and sequencing. In Part 3, we will look at what clinical indicators would possibly be present to support the diagnosis of AKI/ARF.
The FY2021 IPPS Proposed Rule is out and here are some highlights from it regarding ICD-10 Code proposals. We will know if these changes are permanent after the public comment period is over on July 10, 2020 and CMS prepares the Final Rule, usually out by August 1.
As discussed in Part 1 of this series, AKI/ARF is a common diagnosis that coders see daily. In Part 2, we are going to focus on the different types/specificity of AKI/ARF. We’ll learn what they mean, as well as how to code the diagnosis.
This is part 1 in a series focused on coding of acute kidney injury (AKI) and/or acute renal failure (ARF). AKI/ARF is reported often, but is also one of the most common diagnosis found in denials.
With the proliferation of COVID-19 cases, we thought we would put together a quick reference listing of some of the common scenarios that coders have asked about. As with all coding, coders should follow Official Guidelines for Coding and Reporting and the COVD-19 Frequently Asked Questions document by the AHA.
Effective March 1, Medicare will pay physicians for telehealth services at the same rate as in-person visits for all diagnoses, not just services related to COVID-19. This great for providers whose patients are reluctant to visit the office.
The biggest reasons why some hospital systems are moving to single path coding is to eliminate duplicative processes and to optimize productivity. In addition, costs are reduced when only one coder “touches” the record and completes both types of coding.
Effective with 4/1/2020 discharges, ICD-10-CM code U07.0 is used to report vaping -related disorders. ICD-10-CM code U07.0 (vaping related disorder) should be used when documentation supports that the patient has a lung-related disorder from vaping. This code is found in the new ICD-10-CM Chapter 22. U07.0 will be in listed in the ICD-10-CM manual under a new section: Provisional assignment of new disease of uncertain etiology or emergency use.
The US government and public-health officials are urging consumers to utilize telemedicine for remote treatment, fill prescriptions and get medical attention during the new coronavirus pandemic. The goal is to keep people with symptoms at home and to practice social distancing if their condition doesn’t warrant more intensive hospital care.
Coronavirus: Tips for working from home. Companies around the world have told their employees to stay home and work remotely. Whether you’re a new to this concept or a work from home veteran, here’s some tips to staying productive from our #HIAfamily.
This is part two of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. In this part, we discuss mismatches and how to best go about resolving them. In part three we will provide a case example of best practice interaction.
This is part one of a three part series in which we address how coders can better interact with Clinical Documentation Integrity (CDI) professionals. Many times these departments are separate and the remote environment makes it difficult to interact efficiently between the two departments. In part one, we will discuss the history and objectives of CDI so the coder has a better understanding of CDI’s role.
One reason that coders should report chronic conditions (including history and status codes) on outpatient records is the HCC’s—Hierarchical Condition Categories. The quick and easy explanation of what HCC’s are is each HCC is mapped to certain ICD-10-CM codes or code ranges. HCC coding is designed to estimate future health care costs for patients.
For Part 5 of this 5-part series, we will look at Chapter 4 within ICD-10-CM—E00-E89—Endocrine, Nutritional, and Metabolic Diseases. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.
For Part 4 of this 5-part series, we will look at Chapter 10 within ICD-10-CM—J00-J99—Diseases of the Respiratory System. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.
For Part 3 of this 5 part series, we will look at Chapter 9 within ICD-10-CM—I00-I99—Diseases of the Circulatory System. This chapter contains so many of the everyday diagnoses that we code such as hypertension, heart disease and stroke.