New CPT Codes - Integumentary, Musculoskeletal Systems

This is Part 1 of a five part series on the new 2022 CPT codes.  In this series we will explore the CPT changes for CY2022 and include examples to help the coder understand the new codes.  For 2022 in general, there were 249 new CPT codes added, 63 deleted and 93 revised.

In this series we will also include category III procedures as they pertain to the body system procedures discussed. Although they are not located in the surgery section, many of the category III additions involve surgical procedures.

 

Integumentary Sub-Section

There was only one code revision, and that was for code 11981, Insertion Drug-Delivery implant (i.e., bioresorbable, biodegradable, non-biodegradeable).  The bolded terms were added to make the code more accurate. If a biodegradable or bioresorbable implant is removed, use 17999.

New category III code 0658T, Electrical impedance spectroscopy (EIS) of 1 or more skin lesions for automated melanoma risk score was added. The EIS device consists of a handheld probe with a disposable electrode that is applied directly on the skin and uses electrical impendence differences to differentiate between normal and abnormal skin lesions. The EIS algorithm is best used on lesions that are deemed clinically suspicious and has a high sensitivity in detecting malignant melanoma.

The remainder of updates in this sub-section are for the descriptions under “Repair and/or Reconstruction.”   Basically the AMA made the descriptions read more clearly, but did not change the actual intent.   They added “chemical cauterization” and “electrocauterization” as types of wound closures that should be coded with the appropriate E/M code.

Also they added “Hemostasis and local or topical anesthesia, when performed, are not reported separately” under simple repair.

 

Musculoskeletal Sub-Section

Overall Introduction notes updated (re-iterated at cast/strapping subsection):

  • All services in this chapter include application and removal of FIRST cast, splint or traction device.  Supplies reported separately.  If cast is removed by someone other than professional who put it on, the provider taking it off reports the removal code, 29070, 29705, 29710.
  • Subsequent replacement of case, splint or strapping 29000-29750 or traction 20690-20692 during or after the global period may be reported separately.

Notations were added and updated such as:  There is no correlation between the type of fx/dislocation

(open, closed) and the type of treatment (open, closed, percutaneous). The types of treatment definitions

have been reworded and expanded. Explanation of when to use modifier -54 Surgical Care Only was added.

Closed treatment of nasal bone fracture code 21215 was amended to read “with manipulation” and either

without stabilization or with stabilization (21320). Closed treatment is coded to the E/M code.

 

Arthrodesis Codes

Definitions for corpectomy, facetectomy, foraminotomy, hemilaminectomy, lamina, laminectomy, laminotomy have been added to this subsection. It is very important that the coder read these in detail.

Visual definitions of spinal anatomy and procedures were added as well which is a HUGE help for coders in understanding what these spinal procedures involve.  The photos include laminectomy, approaches and such.  Here is one example:

►Definitions◄

►Corpectomy: Identifies removal of a vertebral body during spinal surgery.◄

These are different than interbody arthrodesis.  In corpectomy, rarely is total vertebra removed. The corpectomy as to be greater than 50% cervical, or 33% or greater on thoracic and lumbar. MD will need to document this!  If less than 33% or 50%, technically does not mean corpectomy. Review the images in CPT book along with descriptions.

Added:  Decompression performed on the same vertebral segment(s) and/or interspace(s) as posterior lumbar interbody fusion that includes laminectomy, facetectomy, and/or foraminotomy MAY BE separately reported using 63052, 63053 (New codes created for decompression during posterior interbody arthrodesis)  More on that when we discuss neurology changes.

Decompression SOLELY to prepare the interspace for fusion is NOT separately reported.   The notes were updated on arthrodesis codes to reflect this fact.

Codes 22600-22614 for arthrodesis, posterior or posterolateral technique, replaced the term “level” with “interspace” to be consistent within the chapter.   Coders can get confused with terms such as “level,” “segment,” and “interspace.”   Look at page 164 in the CPT Professional book for an excellent photo that depicts the “segment” vs “interspace.” Vertebral level examples would be level C3, level T2, or level  L4. A vertebral segment describes the basic constituent part into which the spine may be divided. It represents a single complete vertebral bone with its associated articular processes and laminae. A vertebral interspace is the nonbony compartment between two adjacent vertebral bodies which contains the intervertebral disc and includes the nucleus pulposus, annulus fibrosus, and two cartilaginous endplates.

Two codes, 0656y and 0657T were added for vertebral body tethering either up to 7 segments or 8 or more.  This is different than fusion and the rods and screws are placed on the side of the vertebra, to allow movement, unlike fusion in which flexible cord and anchors are placed in the back, with bone graft, and do NOT allow movement.

In  Part 2, we will discuss cardiovascular CPT 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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