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.

Musculoskeletal System

For this musculoskeletal, there are no new codes however major revisions to codes that frequently use.

The notes for assigning arthroscopic loose body removals is now much more stringent.  Arthroscopic removal of loose body(ies) or foreign body(ies) (i.e., 29819-shoulder, 29834-elbow, 29861-hip, 29874-knee, 29894-ankle, 29904-subtalar joint) may now only be reported when the loose body(ies) or foreign body(ies) is/are equal to or larger than the diameter of the arthroscopic cannula(s) used for the specific procedure, and can only be removed through a cannula larger than that used for the specific procedure or through a separate incision, or through a portal that has been enlarged to allow removal of the loose or foreign body(ies).

If removing loose bodies through same portals, surgeon must document he/she is changing out cannula for a larger one!  The surgeon must also document sizes of cannulas/loose bodies or reader must be able to discern in documentation that loose body(ies) meet the above requirements (ie, separate incision or enlarged incision, exchange of cannula for larger one etc.)  This is going to add more documentation burden on the physician.

For the shoulder, arthroscopic debridement definitions were further expanded with requirements as follows:

• 29822 Arthroscopy, shoulder, surgical; debridement, limited, 1 or 2 discrete structures (eg, humeral bone, humeral articular cartilage, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body(ies)
• 29823 Arthroscopy, shoulder, surgical; debridement, extensive, 3 or more discrete structures (eg, humeral bone, humeral articular cartilage, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body(ies)

Coders must note that the exact areas of the shoulder that must be documented to discern which code to assign. Physician should be educated about this change so that can they start dictating these areas  debrided in their operative notes. When in doubt, coders must query. If coders are not familiar with the areas anatomically, they can review photos online to discern shoulder anatomy.

There are also new Category III codes for musculoskeletal procedures:

• 0594T Osteotomy, humerus, with insertion of an externally controlled intramedullary lengthening device, including intraoperative imaging, initial and subsequent alignment assessments, computations of adjustment schedules, and management of the intramedullary lengthening device

             (Do not report in conjunction with codes 20696, 24400, 24410, 24420, 24516, which  are the

             external fixator and  osteotomy codes)

• 0627T Percutaneous injection of allogeneic cellular and/or tissue- based product, intervertebral disc, unilateral or bilateral injection, with fluoroscopic guidance, lumbar, first level
• +0628T Each additional level
• 0629T Percutaneous injection of allogeneic cellular and/or tissue- based product, intervertebral disc, unilateral or bilateral injection, with CT guidance, lumbar, first level
• +0630T Each additional level

Allogeneic based products are injected into the intervertebral disc for patients with discogenic chronic low-back pain from disc disease such as degenerative disc disease.  The physician thaws and prepares cell solution and allograft, draws into 3-mL into syringe and injects needle, using fluoroscopic imaging.  1.35-1.75 mL is injected.  DiscGenics is one of several companies that produces this.

Respiratory System

There is a new code for lateral wall implant insertions:

• 30468 – Repair of nasal valve collapse with subcutaneous/submucosal lateral wall implant(s)

For repair of nasal vestibular stenosis or collapse without cartilage graft, lateral wall reconstruction, or subcutaneous/submucosal implant (eg, radiofrequency remodeling bilateral wall suspension, or stenting without graft or subcutaneous/submucosal implant), use 30999.  Also, do not report 30468 with 30465 – Repair of nasal vestibular stenosis on the same claim.  LATERA® by Stryker is one example. 

There is a new code for biopsy of lung:

• 32408 – Core needle biopsy, lung, or mediastinum, percutaneous, including imaging guidance, when performed  (1 lesion sampled)  Use code 32408-59 for each separate lesion on the same encounter.  A core needle biopsy uses a needle designed to obtain a core sample of tissue for histopathologic evaluation. A FINE NEEDLE ASPIRATION (FNA) biopsy is performed when material is aspirated with a fine needle and the cells are examined cytologically.  Read the new introductory notes at code.

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.