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.
Urinary/Male Reproductive System – Prostate Commissurotomy and HIFU Prostate Ablation
Although there were no new urinary codes, there was an update and are two new codes that address prostate procedures.
▲ 50690 Injection procedure for visualization of ileal conduit and/or ureteropyelography, exclusive of radiologic service
(For radiological S&I see 74420 for retrograde or 74425 for antegrade injection)
The note under the code was updated note to differentiate between retrograde and antegrade S&I.
- 0619T Cystourethroscopy with transurethral anterior prostate commissurotomy and drug delivery, including transrectal ultrasound and fluoroscopy, when performed.
In this procedure, the surgeon performs division of the anterior prostatic commissure and the bladder neck (but sparing the mucosa) to achieve “urethral decompression”. This simple technique is performed for the treatment of benign prostatic hypertrophy. This new code depicts a cystoscopy and transurethral approach to the procedure. There are extensive “Do not report” notes with this code.
- 55880 Ablation of malignant prostate tissue, transrectal, with high intensity-focused ultrasound (HIFU), including ultrasound guidance is a new code for treating prostate cancer. HIFU uses sound waves that a doctor points through the wall of the rectum. They’ll direct the waves at the cancer cells. The sound waves heat up to temperatures as high as 90 C (194 F) and can kill cancer cells in just a few seconds. Doctors use magnetic resonance imaging (MRI) and ultrasound imaging to find out exactly where the tumor is and where to point the sound waves. It takes 1-4 hours to perform.
Female Reproductive Systems – Computer Mapping with Colposcopy
There is a new add on code +57465 Computer-aided mapping of cervix uteri during colposcopy, including optical dynamic spectral imaging and algorithmic quantification of the acetowhitening effect (list separately in addition to code for primary procedure)
This procedure is usually reported with procedures 57420-57421, 57452-57461 for various colposcopic procedures. The acetic acid (vinegar) washes away mucus and allows abnormal areas to be seen more easily with the colposcope. … The areas that stain white after the acetic acid wash are called “acetowhite lesions.”
Codes 57112 for vaginectomy with removal of paravaginal tissue and 58293 for vaginal hysterectomy – Marshall-Marchetti-Granz type or Pereyra type were deleted as they are no longer used.
Two new codes were created for temporary intraurethral valve-pump that treats stress incontinence. The patient has an inflow device inserted which resides in situ in the urethra. The patient then uses a remote control device that activates the small magnetic pump in the urethra that allows voiding.
- 0596T Temporary female intraurethral valve-pump (ie, voiding prosthesis); initial insertion, including urethral measurement
- 0597T Replacement
(Do not report with 51610, 51700-51705 which are the insertion of bladder catheter codes)
Nervous System – Updated Spinal Injection Codes
Spinal puncture codes were updated to make them non-parent codes to parent code 64400. This rectifies an error in last year’s CPT book.
▲64455 plantar common digital nerve(s) (eg, Morton’s neuroma)
▲64479 transforaminal epidural, with imaging guidance (fluoroscopy or CT), cervical or thoracic, single level
▲+64480 transforaminal epidural, with imaging guidance (fluoroscopy or CT), cervical or thoracic, each additional level
▲64483 transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, single level
▲+64484 transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, each additional level
Craniectomy codes 61870 and 62163 along with laminectomy codes 63180 and 63182 have been deleted due to low utilization of these codes.
Ocular and Auditory Systems
New and revised codes were added as follows:
- 0616T – Insertion of iris prosthesis, including suture fixation and repair of removal of iris, when performed; without removal of crystalline lens or intraocular lens, without insertion of intraocular lens
- 0617T – with removal of crystalline lens and insertion of intraocular lens
- 0618T – with secondary intraocular lens placement or intraocular lens exchange
This is a procedure that addresses the replacement of the iris with a prosthesis. This is done in patients with aniridia, which is absence of the iris and traumatic injury to the iris.
- 0621T – Trabeculostomy ab interno by laser
- 0622T – with use of ophthalmic endoscope
Excimer Laser Trabeculostomy (ELT) is one example. This procedure creates ten openings in the trabecular meshwork and inner wall of Schlemm’s canal. Ab interno means to DECREASE intraocular pressure by increasing aqueous outflow through an opening in the trabecular meshwork.
For the auditory system, two new codes were created:
- 69705 Nasopharyngoscopy, surgical, with dilation of eustachian tube (i.e, balloon dilation) unilateral
- 69706 bilateral
(Do not report 69705, 69706 in conjunction with 31231, nasal endoscopy)
There is now a code for the nasopharyngoscopy approach to dilate the eustachian tube. Balloon dilation
of the Eustachian tubes is an endoscopic procedure that usually approaches the Eustachian tubes
nasally, and using a balloon catheter, expands and stretches the Eustachian tube. It is proposed to
relieve chronic ear congestion and middle ear and mastoid infections.
Our final Part 5 of the series will cover miscellaneous CPT updates not covered thus far such as Evaluation and Management and some Category III codes not previously discussed.
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.