Part 2: New 2020 CPT Codes | Musculoskeletal System
RHIA, CDIP, CCS, CCS‑P, CIRCC
Executive Director Of Education
AHIMA‑Approved ICD‑10‑CM/PCS Trainer and Ambassador
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.
Needle Insertions Without Injections
For awhile now, physical therapists, physicians and other qualified health care providers have been performing dry needling, or otherwise known as “trigger point acupuncture.” We now have new codes for this procedure: ● 20560 Needle insertion(s) without injection(s) 1 or 2 muscles
- 20561 – 3 or more muscles
In “dry needling” nothing is injected into the patient. The provider inserts needles to release tight tissue or knots to improve microcirculation, remove neurotoxins and to relieve pain. This is many times done in the physician’s or physical therapist’s office.
Insertion of Drug Delivery Devices
The AMA has added the following new codes for insertion and deletion of drug delivery devices, by area inserted. NOTE THAT THESE ARE ALL ADD-ON CODES!
- +20700 Manual preparation and insertion of drug-delivery device(s), deep (eg, subfascial) (List separately in addition to primary procedure) (usually polymethylmethacrylate beads on a wire with Tobramycin or Vancomycin)
- +20701 Removal of drug-delivery device(s), deep (eg, subfascial) (List separately in addition to primary procedure)
- +20702 Manual preparation and insertion of drug-delivery device(s), intramedullary (List separately in addition to primary procedure) (mostly trauma surgeons, beads like above)
- +20703 Removal of drug-delivery device(s), intramedullary (List separately in addition to primary procedure)
- +20704 Manual preparation and insertion of drug-delivery device(s), intra-articular (List separately in addition to primary procedure) (Spacer out of box is inherent (i.e. in 27488) and not coded separately)
- +20705 Removal of drug-delivery device(s), intra-articular (List separately in addition to primary procedure)
Use 20680 if removal only. Report once per anatomic area per encounter.
Codes 11981 11982 and 11983 are for pre-mixed, jarred or boxed spacers that already have the drug infused into them (The physician does not have to mix them.) The coder must be able to discern the type of drug delivery device within the documentation to assign codes accurately.
Manual mixing is a REQUIRED part of the new codes that involves mixing and preparation of antibiotics or other therapeutic agents with a carrier substance by the physician or QHP during the surgical procedure. The provider then shapes that mixture into the drug delivery device.
Articulating spacers are implants done for revisions, not a drug delivery system. (i.e. use 27487 for example, alone) Coders are cautioned not to confuse the two.
Patient has debridement of infected bone and soft tissue of the right thigh area. On the back table, the dead space is measured and polymethylmethacrylate (PMMA) powder is mixed antibiotic powder (tobramycin and vancomycin are common). A liquid monomer is added to mix the materials in a vacuum-mixing system. As the cement begins to harden it is rolled into long rods 1.5 to 2.0 cm in diameter and cut into small segments. Beads are threaded onto suture and allowed to harden. The sting of beads is set into the defect sub-fascially with a metallic clip for marker.
Assign 11044 for the debridement including bone and +20700 for the drug delivery device.
Chest Wall Tumor Excision
There are three new codes replacing three previous codes in the integument system for excision of chest wall tumors:
- 21601 Excision of chest wall tumor including rib(s)
- 21602 Excision of chest wall tumor involving rib(s), with plastic reconstruction; without mediastinal lymphadenectomy
- 21603 with mediastinal lymphadenectomy
This is frequently done with mastectomies. These codes had been in the integument system since they were associated with mastectomies but those codes were deleted (19260 19271 19272).
The intent remains the same. The AMA just changed 19260, 19271, 19272 to 21601, 21602, 21603.
Touch Bone Biopsy and Bone Strength Fracture Risk
Two new Category III codes for two musculoskeletal diagnostic procedures were added:
- 0547T – Bone material quality testing by micro-indentation(s) of the tibia(s), with results reported as a score.
This code completes with the DEXA scan (77080, 77081) in trying to measure how strong a bone is such as the tibia. This procedure is typically performed in an office.
The procedure involves trying to dent the bone and the a score is recorded and lets the physician know the strength of the bone and general bone health. The name is really a misnomer as there is no biopsy done.
- 0554T – 0558T Bone strength and fracture risk using finite element analysis, interpretation and report or retrieval and transmission of scan data, assessment of bone strength, interpretation and report of bone strength, CT scan for purpose of analysis. This is bone mass measurements for diagnosis.
Autologous Cellular Implant Knee
Two more new Category III codes were added for autologous cellular implant to knee:
- 0565T – Autologous cellular implant derived from adipose tissue for the treatment of osteoarthritis of the knees; tissue harvesting and cellular implant creation
It has various steps that must be performed, unlike other codes. For example, tissue harvest, incision closure, tissue washing, tissue enzymatic dissociation, cellular implant concentration from dissociated tissue, cellular implant resuspension and extraction, dose construction, yield assay, etc. The coder must review the notes for this code in the CPT manual.
(Do not report 0565T in conjunction with 15769, 15771-15774)
- 0566T – Injection of cellular implant into knee joint including ultrasound guidance, unilateral
(Do not report 0566T in conjunction with 20610, 20611, 86942, 77002) (For bilateral procedure use -50)
In Part 3 we will discuss the cardiovascular 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.
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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).
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We’re finally at the #1 most common DRG with recommendations by HIA for 2019. Just to recap, HIA reviewed over 50,000 inpatient records in 2019. Most have probably already guessed what the correct DRG would be with the most recommendations. There are just some diagnoses and DRG’s that will always be a thorn in the side for coders. #1 DRG with the most recommendations during HIA reviews : DRG 871—Septicemia or severe sepsis w/o mechanical ventilation >96 hours with MCC
We’re now at the second most common DRG with recommendations by HIA for 2019. Just to recap, HIA reviewed over 50,000 inpatient records in 2019. We are counting down to # 1. #2 DRG with the most recommendations during HIA reviews: DRG 872—Septicemia or severe sepsis w/o mechanical ventilation >96 hours w/o MCC.