CPT Code Updates impacting Orthopedics in 2020

New, revised, and deleted CPT codes and coding guidelines became effective Jan. 1, 2020. Like all specialties, orthopedic practices need to stay updated on the latest coding updates and rules to prevent denials. In FY2020, changes for chiropractic and orthopedic medical billing include several new musculoskeletal CPT codes and one deleted code.

Let’s take a look at the key 2020 musculoskeletal CPT code updates relevant to physical therapists, physicians, and other qualified health care providers (QHPs).

• 2 Dry Needling Codes

Dry needling involves inserting several filiform needles into trigger points” in the muscle or tissue. No fluid is injected in this technique which is also called intramuscular stimulation or “trigger point acupuncture”. Dry needling releases knotted or hard muscle and improve microcirculation, remove neurotoxins, and relieve pain or spasms. The practitioner will determine the length of time that the needles need to remain in the skin. In 2020, there are two new CPT codes for needle insertions without injections:

20560 Needle insertion(s) without injection(s) 1 or 2 muscles
20561… 3 or more muscles

• 6 Add-on Codes for Drug Delivery Device Implantations

Implantable drug delivery systems allow targeted drug delivery at a consistent, predetermined rate. They enable optimal dosing during treatment, minimize potential side effects, and improve treatment efficacy. Implantable drug delivery devices are widely used in diseases that need long term therapy or posepatient compliance problems, such as cardiovascular disease, tuberculosis, diabetes, cancer, and chronic pain management.

In orthopedic surgery, drug-releasing implants allow local drug delivery to the bone to treat infection. These implants come in various sizes, from a tiny “antibiotic bead” to an antibiotic loaded cement knee prosthesis spacer. Drug delivery implants can be biodegradable or non-biodegradable. Non-biodegradable antibiotic implants implanted during surgery to relieve post-op pain will be removed in the office as part of the post-op care services.

There are 6 new add-on codes for the manual preparation and insertion as well as removal of implants for the delivery of drugs to deep musculoskeletal spaces:

• 20700 Manual preparation and insertion of drug-delivery device(s); deep(eg, subfascial) (List separately in addition to primary procedure) (usually polymethylmethacrylate beads on a wire with Tobramycin or Vancomycin)
• 20702… Manual preparation and insertion of drug-delivery device(s), intramedullary (List separately in addition to primary procedure) (mostly trauma surgeons, beads like above)
• 20704… Manual preparation and insertion of drug-delivery device(s), intra-articular (List separately in addition to primary procedure) (Spacer out of box is inherent (i.e. in 27488) and not coded separately)
• 20701 Removal of drug-delivery device(s); deep(e.g., subfascial) (List separately in addition to primary procedure)
• 20703 Removal of drug-delivery device(s), intramedullary (List separately in addition to primary procedure)
• 20705 Removal of drug-delivery device(s), intra-articular (List separately in addition to primary procedure)

Coding drug delivery implantations – points to note

• These services are add-on codes and always reported in conjunction with other procedures. The primary codes with which the add-on codes can be reported are indicated in the parenthetical notes.
• The new 2020 add-on codes by area inserted can be reported once per anatomic location.
• The new codes for drug delivery involve manual mixing and preparation of antibiotics or other therapeutic agents with a carrier substance by the physician or QHP during the surgical procedure. The mixture is then placed on the delivery device such as nails, beads, or spacersby the provider.
• Drug delivery implants that come premixed or boxed already have the drug infused into them. This implies that no manual mixing by the physician is required. The CPT codes to report premixed drug delivery implants are:
  • 11981 Insertion, non-biodegradable drug delivery implant
  • 11982 Removal, non-biodegradable drug delivery implant
  • 11983 Removal with reinsertion, non-biodegradable drug delivery implant
• Medical coders need to know how to identify the type of drug delivery system from the clinical documentation and correctly assign drug delivery implant codes. For instance, a Health Information Associates (HIA) article cautions that coders should not confuse articulating spacers with drug delivery systems. Articulating spacers are implants done for revisions and should be reported using CPT code 27487 (Revision of total knee arthroplasty, with or without allograft; 1 component).

• 2 New Category III Codes for Autologous Cellular Implant to Knee

The 2020 AMA CPT Manual includes 2 new Category III codes for implants created by harvesting adipose tissue and injected into the knee for treatment of osteoarthritis:

• 0565T Autologous cellular implant derived from adipose tissue for the treatment of osteoarthritis of the knees; tissue harvesting and cellular implant creation
• 0566T Autologous cellular implant derived from adipose tissue for the treatment of osteoarthritis of the knees; injection of cellular implant into knee joint including ultrasound guidance, unilateral

• Category III Codes for 2 Musculoskeletal Diagnostic Procedures

New Category III codes have been added for two musculoskeletal diagnostic procedures: bone strength and fracture risk assessments and touch bone biopsy:

Bone strength and fracture risk assessments

0554T bone strength and fracture risk using finite element (FE) analysis of functional data, and bone-mineral density, utilizing data from a computed tomography (CT) scan; retrieval and transmission of the scan data, assessment of bone strength and fracture risk and bone mineral density, interpretation and report

• 0555T…retrieval and transmission of the scan data
• 0556T…assessment of bone strength and fracture risk and bone mineral density
• 0557T…interpretation and report

Revenue Cycle Advisor provides the following key information on these new codes:

• 0554T describes all components of an FE and CT analysis used to measure bone strength and density: obtainment (by the physician) of bone mass measurements and data on bone-mineral density from previously obtained CT scans, assessment of bone strength, density, and fracture risk, and a written report.
• 0555T-0557T describe individual components of the bone strength and fracture risk analysis. To describe the performed service, coders should report as many of these codes as necessary.
• Codes 0555T-0557T should not be reported with code 0554T.

Touch bone biopsy

• 0547T Bone material quality testing by micro-indentation(s) of the tibia(s), with results reported as a score.

In outsourced medical billing companies, the team stays up-to-date on recent coding changes. Orthopedic medical billing and coding experts will review the physician’s documentation to ensure that it clearly specifies the nature of the procedure performed. This will allow appropriate billing and reporting to avoid denials and ensure optimal reimbursement for services rendered.