Published 2/1/2019
Sarah Wiskerchen, MBA, CPC

CPT Code Updates Surgeons and Staff Need to Know

It’s a new year, and along with it come additions, deletions, and changes to Current Procedural Terminology (CPT) codes. Here are eight essential updates that surgeons, coders, and billing staffs must understand to code accurately and get paid in 2019.

  1. New bone allograft codes

Three new add-on codes are effective in 2019: 20932, 20933, and 20934. Each describes a type of structural allograft. By definition, the codes include the work of templating, cutting/shaping, placement, and internal fixation and are differentiated by the type of allograft—osteoarticular, hemicortical intercalary (partial), and intercalary (complete).

Specific guidelines within CPT direct users to surgical procedure codes with which the allograft codes can and cannot be reported; for example, 20934 is not reportable in conjunction with total hip arthroplasty (THA) or conversion to THA. Collectively, the codes may typically be used in reconstruction after tumor and trauma surgery. The three codes are not reportable together; all are add-on codes to a primary procedure, such as a tumor resection code. These are different than the allograft codes used in spine surgery (20930 and 20931).

  1. Replacement code for knee arthrography injection code 27370

To date, CPT code 27370 has been used to describe an injection for contrast knee arthrography. This code was deleted in 2019 and replaced with a new code: 27369, which combines the definition of deleted code 27370 and adds the component of injection for contrast-enhanced CT/MRI knee arthrography, reflecting current clinical practice. Per CPT guidelines, code 27369 can be used in conjunction with specific radiologic services but is not reportable in conjunction with major joint injection procedure codes 20610 or 20611, or with knee arthroscopy code 29871.

  1. New and revised codes for insertion, removal, and exchange of sinus tarsi implant

Foot and ankle specialists and podiatrists may find these codes useful. The codes that describe these services are all classified as Category III, do not have Centers for Medicare & Medicaid Services relative value unit values assigned, and are carrier priced. It’s important to check payer coverage policies for non-Medicare plans.

Prior to 2019, CPT code 0335T was defined as “extra-osseous subtalar joint implant for talotarsal stabilization.” The revised definition in 2019 specifically designates the location of the implant as the sinus tarsi and the activity as implant insertion.

Codes 0510T and 0511T are new this year and describe removal of the sinus tarsi implant or removal and reinsertion of the implant, respectively. Per CPT guidelines, it is not appropriate to use hardware removal codes 20670 or 20680 instead of 0510T or 0511T, because the new codes are the most specific for removal of that device type. Insertion of a sinus tarsi implant is not separately reportable in conjunction with open treatment of talotarsal joint dislocation, subtalar arthrodesis (open or arthroscopic).

  1. Revised definitions and nine new fine needle aspiration (FNA) biopsy codes

Prior to 2019, CPT codes 10022 and 10021 were used to describe FNA with or without image guidance, respectively. This year, code 10021 is revised, adding “biopsy” and “first lesion.” Code 10022 is deleted and replaced with nine codes that describe FNA with specific methods of imaging guidance (ultrasound, fluoroscope, CT, and MRI) or add-on codes for each additional lesion, including for primary service 10021.

Detailed guidelines within CPT outline how FNA services can be billed in conjunction with core needle biopsy, either on the same lesion or on a separate lesion, or by the same or a different imaging method.

  1. Revised guidelines and new codes for neurostimulator analysis and programming

Spine surgeons who utilize neurostimulators must pay attention to changes made in codes 95970, 95971, and 95972. The guidelines for these codes are revised to differentiate analysis and programming services, and the different types of parameters have been modified.

In addition, there are four new codes for cranial nerve and brain stimulator programming: 95976, 95977, 95983, and 95984.

  1. Changes to interprofessional telephone/internet/electronic health record (EHR) consultative services

Codes 99446, 99447, 99448, and 99449 are time-based codes used to describe “interprofessional telephone/internet/EHR assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified healthcare professional.” Although these codes were effective in 2014, this year’s change adds the element of EHR to the code descriptions.

Codes 99451 and 99452 are new in 2019 and are differentiated from the existing codes by the exclusion of a verbal report requirement in code 99451 and the creation of a “referral service” code 99452. As described by the American Medical Association in “CPT Changes: An Insider’s View 2019,” this code would include the physician’s work of “reviewing records, assembling pertinent materials, developing clinical questions/concerns, and transmitting this information to the appropriate consultant. As needed, the treating/requesting physician directly communicates with the consultant.”

The CPT guidelines for these codes explain that there are reporting limitations. For example, if the consultant has seen the patient within the past 14 days, the codes are not reportable. Similarly, if the consultation leads to an appointment “within the next 14 days or next available appointment date of the consultant,” or if the purpose of the communication is to arrange a transfer of care, codes 99446–99449 are not reported. The codes include all time spent on review of medical records, including imaging, pathology, and laboratory results and specimens. To qualify for reporting, the majority of the service time must be spent on verbal or internet discussion (greater than 50 percent). If greater than 50 percent is instead spent on data review and/or analysis, the codes are not reportable. As a result, it is essential to document how time is spent.

Keep in mind, these codes are not used for non-face-to-face telephone or online consultations with patients, parents, or guardians; those are reported via codes 99441–99444. Coverage for codes 99441–99444 varies by payer and, by definition, includes restrictions when the communication originates following a face-to-face visit and/or leads to a face-to-face visit.

  1. Changes and additions to central nervous system assessments/tests

Numerous changes and additions have been made in the Medicine section of CPT in the areas of neurocognitive and mental status assessment and testing. These codes could have orthopaedic and sports medicine applications in the area of concussion management.

  1. A few deleted codes

Code 20005—incision and drainage of soft tissue abscess, subfascial (i.e., involves the soft tissue below the deep fascia)—is deleted this year, and guidelines instruct users to instead utilize appropriate anatomic site-specific incision and drainage codes.

In spine, transcutaneous electrical nerve stimulation (TENS) code 64550 (application of surface [transcutaneous] neurostimulator [e.g., TENS unit]) is deleted due to misreporting, and users are directed to utilize codes 97014 or 97032.

Also, Category III spine codes 0195T and 0196T, used for presacral interbody arthrodesis, are deleted, and users are instructed to report the service using unlisted code 22899.

Sarah Wiskerchen, MBA, CPC, is a senior consultant with KarenZupko & Associates, Inc., a consulting and education firm that develops and delivers AAOS coding and reimbursement courses. For course information, dates, and to register, visit karenzupko.com.