As we turn the calendar to a new decade, the 2020 CPT code changes take effect. This year there are a total of 394 changes to CPT, bringing the total number of codes to 10,471. This includes 248 new codes, 71 deletions, and 75 code revisions, according to the American Medical Association (AMA). In this article, we will discuss the changes in the Surgery Section. And in Part 2, we will discuss changes in the Evaluation and Management, Medicine, Radiology, and Pathology and Laboratory sections, along with an overview of the new Category III codes. Visit YES HIM Consulting’s Education Portal for courses on the 2020 CPT updates. Stay up-to-date on the 2020 ICD-10-PCS guideline changes.
The Surgery section had a total of 38 new codes with 37 revisions and 17 deletions.
The Integumentary subsection had 5 new codes and 4 deletions. Though there were no code revisions, the guidelines for intermediate and complex repair were revised to clarify the differences between the two types of repair. Please see the CPT handbook for the detailed definition of intermediate repair, and note that this definition now includes limited undermining, which is specifically detailed in the description. Complex repair includes all the requirements for intermediate repair, as well as one additional element. One of these 4 potential elements is extensive undermining, which is specifically defined in the guidelines, and an image was added to the CPT handbook to illustrate extensive undermining. Additionally, the references to scar revision and stents were removed from the complex repair guidelines. Carefully review these revised guidelines.
There are 5 new codes for tissue grafting. The first code, 15769, is used for grafting of autologous soft tissue via an excisional technique and placement in a defect for reconstruction. The remaining 4 codes are for adipose cell harvesting using liposuction, also known as lipofilling. In these services, the cells harvested via liposuction are minimally prepared and injected in small aliquots, or a portion of a larger whole, into the defect. The codes are differentiated by anatomical sites that receive the graft and the amount of injectate; with 15771 for grafting to the trunk, breasts, scalp, arms, and/or legs for 50 ccs or less of injectate, with add-on code 15772 for each additional 50 ccs or part thereof. For the anatomic sites of face, eyelids, mouth, neck, ears, orbits, genitalia, hands and/or feet, code 15773 is used for the first 25 ccs or less of injectate, with add-on code 15774 for each additional 25 ccs or part thereof.
Code 20926 for tissue grafts other was deleted with references to these codes. The 3 codes for excision of chest wall tumor were deleted, though these codes were added to the musculoskeletal subsection, which is a more logical placement. There was one deletion for breast procedures, 19304, for subcutaneous mastectomy. See the revised guidelines for breast biopsy, mastectomy, and other breast procedures in the anatomic heading for Breast in CPT.
The Musculoskeletal subsection has a total of 11 new codes. Of these additions, 3 codes for excision of chest wall tumor were in the Integumentary subsection and have been moved to 21601, 21602, and 21603, depending on the extent of the excision. There are 2 new codes for needle insertion(s) without injections, also known as dry needling or trigger-point acupuncture. The codes 20560 and 20561 are distinguished by the number of muscles involved, and there are new guidelines and parentheticals for these codes. Finally, there are 6 new add-on codes, 20700-20705, for preparation/insertion and removal of drug-delivery devices. The codes are distinguished based on the location: deep, intramedullary, or intraarticular, and whether this is preparation and insertion, or removal of the device. These codes are not used for prefabricated or “out of the box” devices; important new guidelines accompany the codes.
Respiratory and Cardiovascular Subsections
There were no new codes in the Respiratory subsection, with 9 code revisions and updated guidelines for nasal/sinus endoscopy codes. As always, there were several changes in the Cardiovascular subsection, with 2 revisions, 11 new codes and 8 code deletions. There are 4 codes for procedures on the pericardium, 33016-33019 were added, with the codes distinguished by whether or not an indwelling catheter is inserted. Other factors guiding code selection are the type of imaging guidance, age of the patient, and the presence of a congenital cardiac anomaly. This is accompanied by the deletion of 3 codes; 33010, 33011, and 33015, with parentheticals referencing the new codes. Code 33275, established in 2019 for removal of a leadless pacemaker, was revised to include imaging guidance when performed.
New codes for ascending aorta grafts, 33858 and 33859, replace deleted code 33860, with the latest codes distinguishing between these grafts for aortic dissection versus other aortic diseases, such as an aneurysm. Code 33870 for transverse arch graft was deleted and replaced with 33871, which added descriptions of additional procedures included in the code. There are parentheticals and guidelines that specify 33871 is used for a complete versus hemiarch graft procedure. New codes 34717 and 34718 for iliac branched endograft (IBE) placement replace deleted Category III code 0254T. The code 34717 is an add-on code when the IBE placement is done at the same time as an aortoiliac artery endograft placement, while 34718 is used when the IBE placement is done on its own. There are important notes, guidelines, and parentheticals for both of these codes.
Codes for exploration of an artery were revised with code deletions, a revision, and two new codes. The codes now are organized by the neck, upper extremity, and lower extremity arteries, and the description of with or without lysis of the artery has been removed. Existing parent code 35701 now describes exploration of neck artery rather than specifically the carotid. The new code 35702 is for upper extremity artery, and 35703 for lower extremity artery. This resulted in the deletion of codes 35721, 35741, and 35761 for exploration of the femoral, popliteal, and other vessels. Important notes and parentheticals accompany new guidelines for these codes.
In the Digestive subsection, code 43401 for transection of the esophagus with repair for esophageal varices was deleted due to low utilization, and the service does not represent current practice. Codes for transanal hemorrhoidal dearterialization were updated, with conversion of Category III codes, code revisions, and new codes. Codes 46945 and 46946 were revised to indicate that imaging guidance is not included in the code. New code 46948 is the converted code for deleted Category III code 0249T for transanal hemorrhoidal dearterialization of two or more hemorrhoid columns, including ultrasound guidance. This is a distinct procedure from traditional hemorrhoidectomy that includes the removal of the hemorrhoid bundle. Finally, 2 new codes for preperitoneal pelvic packing were added. Code 49013 is for this packing associated with pelvic trauma, while 49014 is for re-exploration. Note that a laparotomy is not associated with these codes; instead, a low-horizontal Pfannenstiel is used.
Male Genital and Nervous System Subsections
There is only 1 change in the Male Genital System; a code revision for 54640 that deleted the mention of with or without hernia repair and adding the scrotal approach to the code descriptor. The first group of changes in the Nervous System subsection are on spinal puncture. Codes 62270 and 62272 were revised with the addition of a semi-colon to become parent codes. This allows for the addition of 2 new codes; 62328 for diagnostic and 62329 for therapeutic lumbar puncture with fluoroscopic or CT guidance.
There were code revisions, deletions, and additions in the Somatic Nerve heading for Introduction/Injection of Anesthetic agents for diagnostic or therapeutic purposes. About 18 codes were revised to include the word “steroid” in the code description. The 3 codes, 64402, 64410, and 64413, for facial nerve, phrenic nerve, and cervical plexus were deleted, as the procedures are not commonly performed. Codes 64451 and 64454 were added for these procedures on the nerves of the sacroiliac joint and genicular nerve branches, respectively. In the Destruction by Neurolytic Agent subheading, 2 codes were added; 64624 describes this destruction in the genicular nerve branches, and 64625 is for radiofrequency ablation of nerves of the sacroiliac joint. A new chart is found in CPT directly after code 64451 to assist with code selection, indicating the nerves involved, number of injections, and whether image guidance is included.
Eye and Ocular Adnexa Subsection
Finally, in the Eye and Ocular Adnexa subsection, 3 codes were revised, and 2 codes added. Code 66711 was revised to include without concomitant removal of crystalline lens, and 66982 and 66984 for extracapsular cataract removal were revised to include without endoscopic cyclophotocoagulation. This allows for the creation of new codes 66987 and 66988 for extracapsular cataract removal procedures with endoscopic cyclophotocoagulation. Important guidelines and notes accompany the revised and new codes.
Remaining code changes will be covered in Part 2 of this series.