Part 1 – New 2019 CPT Codes: Integumentary System

by | Jan 14, 2019 | Coding Tips, CPT, Education, New CPT Codes, Patricia Maccariella-Hafey, Series | 0 comments

Patricia Maccariella-Hafey, RHIA, CDIP, CCS, CCS-P, CIRCC has over 35 years expertise in the areas of ICD-9-CM, CPT, DRG/APC validation Professional Fee E&M coding, Interventional Radiology, and Facility E&M coding. Patricia is currently Director of Education a healthcare consulting firm specializing in coding compliance review, education and contract coding services.

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 2019 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 were 15 new integumentary CPT codes added with 3 deletions and 1 revision.

Fine Needle Aspiration Biopsies

Code 10022, FNA with imaging guidance was deleted. One revised and 5 new codes now identify fine needle biopsy by type of imaging guidance. The codes are as follows:
10021 Fine needle aspiration biopsy, without imaging guidance, first lesion
#+10004 each additional lesion (list in addition to primary)
10005 Fine needle aspiration biopsy, including ultrasound guidance, first lesion
#+10006 each additional lesion (list in addition to primary)
10007 Fine needle aspiration biopsy, including fluoroscopic guidance, first lesion
#+10008 each additional lesion (list in addition to primary)
10009 Fine needle aspiration biopsy, including CT guidance, first lesion
#+10010 each additional lesion (list in addition to primary)
10011 Fine needle aspiration biopsy, including MR guidance, first lesion
#+10012 each additional lesion (list in addition to primary)

New notes and explanations are at the beginning of subsection.

  • 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.

If two different biopsy using different imaging modalities on different lesions, use the primary code for each one with -59 on second.

If FNA and CORE biopsies are done on the SAME lesion, same session, same day, same type of imaging guidance, do NOT separately report the imaging guidance for the CORE biopsy with modifier -59:

10007- FNA biopsy including fluoroscopic imaging first lesion
19100-59 – Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate
procedure)

Report the core biopsy code WITHOUT guidance. The same guidance should NOT be reported twice.

If FNA and CORE biopsies are done on SEPARATE lesions, same session, same day, same type of imaging guidance, then report both types of biopsies with imaging guidance, with modifier -59 on second.

Other Biopsies

Six new codes were created to identify differing types of skin biopsies. The codes along with helpful descriptions are below:
11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette) single lesion (Tangential means along a tangent, diverging from previous line)
+11103 each separate/additional lesion (list in addition to primary)
11104 Punch biopsy of skin (including simple closure, when performed); single lesion (uses a punch tool)
+11105 each separate/additional lesion (list in addition to primary)
11106 Incisional biopsy of skin (including simple closure, when performed); single lesion (uses a sharp blade) (most complicated of the three)
+11107 each separate/additional lesion (list in addition to primary)

The coder may have to query the MD if the type of biopsy is not well documented. A punch biopsy uses a punch tool but beware of “punch excision,” where a tool is used to remove lesion with margins.

Do not confuse “tangential” biopsy with shave removal of lesion, 11300-11313. In a biopsy only a portion is shaved off. In shave removal, the entire lesion is removed.

The add on codes can be used with a different primary code if there is more than one lesion. The primary codes are hierarchical with incisional being the most intense, followed by punch and then by the tangential. For example, for 1 incisional biopsy, 1 tangential biopsy and 1 punch biopsy is coded 11106 x1, 11103 x 1 and 11105 x 1. Notice that the incisional biopsy primary code is used, and the add on code for the other two are used.

Other CPT Codes Involving Integument

There are two new codes for ESWT for skin wounds:
0512T Extracorporeal shock wave for integumentary wound healing, high energy, including topical application and dressing care, initial wound
+0513T each additional wound (list in addition to primary)

ESWT treats complex skin and soft tissue wounds without disrupting bone. The coder will see “shock-count delivery” and this is determined by wound volume and comorbidities. High energy shock impulses are delivered to the wound and at least 1 cm around the existing wound.

In Part 2, we will discuss musculoskeletal code changes.

The information contained in this post 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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