Part 2: New 2020 CPT Codes | Musculoskeletal 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 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.
Example:
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.
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.
Latest News
Overview of the 2021 E/M Guideline Coding Changes
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.
Coding Tip: Understanding and Reporting Pseudoseizures
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).
Coding Tip: Coding Bowel Obstruction in ICD-10-CM
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.
Part 5: New 2021 CPT Codes | Modifiers, Category III, Evaluation and Management, etc.
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.
Part 4: New 2021 CPT Codes | Urinary, Nervous, Ocular and Auditory Systems
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.
Part 3: New 2021 CPT Codes | Cardiovascular System
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.
Part 2: New 2021 CPT Codes | Musculoskeletal and Respiratory Systems
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.
Part 1: New 2021 CPT Codes | Integumentary System
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.
2020: Year in Review | Coding Education
In January, new CPT codes were released. There were 248 new CPT codes added, 71 deleted and 75 revised. Most of the surgery section changes were in the musculoskeletal and cardiovascular subsections. These included procedures such as skin grafting, breast biopsies, deep drug delivery systems, tricuspid valve repairs, aortic grafts and repair of iliac artery.
Coding Tip: New COVID-19 Codes Effective January 1, 2021
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.
New Technology Add-On Payments (NTAP) For FY2021 – Part 4
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.
New ICD Codes and IPPS Changes for FY2021 (ICD-10-CM Diagnoses changes) – Part 3
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.
New ICD Codes and IPPS Changes for FY2021 (ICD-10-CM Diagnoses changes) – Part 2
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)…
New ICD Codes and IPPS Changes for FY2021 (ICD-10-CM Diagnoses changes) – Part 1
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)
Coding Tip: Reporting “Flash” Pulmonary Edema
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: $556 increase/record reviewed
“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.
Coding Tip: Glasgow Coma Scale Coding OCG Update for FY2021
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.
Coding Tip: Cardiac Arrest and Cardiac Shock
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.
Client X: Let’s Talk Numbers
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.
Coding Tip: Endarterectomy During Coronary Artery Bypass
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.
Coding Tip: Update – Coding COVID-19 When the Test is Negative
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.
New ICD-10-PCS Procedure Codes for COVID-19
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.
New Rule Helps Medicare ACOs During COVID-19 Pandemic
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.
Part 4: Is Documentation Present to Report Acute Kidney Injury/Failure? | AKI Series
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.
Coding Tip: Z Code Reporting for COVID-19
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).
Part 3: Clinical Indicators for Acute Kidney Injury/Failure | AKI Series
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.
FY2021 Proposed Rule and Code Changes Highlights
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.
Part 2: Specificity Coding of Acute Kidney Injury (AKI) and Sequencing | AKI Series
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.
Part 1: What is Acute Kidney Injury (AKI)? | AKI Series
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.