In 2020, there are 394 CPT code changes, including 248 new codes, 71 deletions, and 75 revisions. Plastic surgery is one of the specialties that has new codes effective January 1, 2020. There are new codes for fat grafting as well as new complex repair guidelines. Companies providing coding and physician billing services can help plastic surgeons utilize the new CPT codes for accurate reporting of services and procedures. Here we discuss three key updates for plastic surgery:
- New CPT codes for fat grafting
- New instructional parentheticals for reporting breast reduction surgery codes
- Updated definitions intermediate and complex repair of lacerations and wounds
New CPT Codes for Fat Grafting: Used in both aesthetic and reconstructive procedures, fat grafting or fat transfer is one of the most popular options for plastic surgery procedures such as breast augmentation, buttock augmentation, facial enhancements, and hand rejuvenation.
Fat transfer involves using the patient’s own fat to enhance specific areas of the body to improve visible signs of aging and several other concerns. Unwanted fat is extracted from specific areas via liposuction, purified and injected into the areas that need enhancement such as the breasts, buttocks, etc. The Brazilian butt lift and composite breast augmentation (a combination of implants and fat grafting) are popular procedures performed using advanced fat transfer techniques.
Fat grafting owes much of its popularity to the fact that it uses autologous tissue to provide natural looking results. Risks of rejection, such as may occur with the insertion of foreign material, are also reduced when the patient’s own fat is used. Recent market research studies revealed that rising preference for the use of non-invasive aesthetic techniques are driving the growth of the autologous fat grafting market. The key factors that make autologous fat grafting continue to gain traction over invasive techniques are:
- Demand for minimally invasive aesthetic techniques
- Less downtime and quicker recovery than invasive surgery
- Regenerative properties of autologous tissue
- Safety and precision of new liposuction methods in autologous fat grafting
- Celebrity endorsements
The CPT code changes for autologous fat grafting effect Jan 1, 2020 include one deleted code (20926) and five new codes (15769–15774) to better represent the many different types of tissue grafts that require different physician work.
Deleted: CPT code 20926 Tissue grafts, other (e.g. paratenon, fat, dermis)
New: Five new CPT codes in the Integumentary system, other flaps and grafts section allow providers to report tissue grafting based on anatomic site and volume:
15769 Grafting of autologous soft tissue, other, harvested by direct excision (e.g. fat, dermis, fascia)
15771 Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms and/or legs; 50cc or less injectate
15772 Each additional 50cc injectate, or part thereof (List separately in addition to code for primary procedure). Code 15772 should be used in conjunction with code 15771
15773 Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands and/or feet; 25cc or less injectate
15774 Each additional 25cc injectate, or part thereof (List separately in addition to code for primary procedure). Cose 15774 should be used in conjunction with 15773
Breast Reduction: Breast reduction surgery is performed to reduce the size of overly large breasts. Breast reduction for women (reduction mammoplasty) removes excess tissue and skin and reshapes the breasts. The procedure also restores the entire nipple and areola complex to the normal position. Male breast reduction is performed to address gynecomastia (abnormal enlargement of the male breast).
In 2020, the CPT changes pertaining to breast reduction are the addition of new instructional parentheticals for reporting the following codes:
- 19300, Mastectomy for gynecomastia, for breast tissue removed for breast reduction for gynecomastia
- 19318, Reduction mammaplasty, for breast tissue removed for breast size reduction for other than gynecomastia
Knowing payer rules is crucial when submitting claims for plastic surgery. Payers generally reimburse breast reduction surgery that is reconstructive and medically necessary and exclude cosmetic procedures from coverage.
Updated Complex Repair Guidelines: Coding changes for plastic surgery also includes updated definitions for intermediate and complex repair of lacerations and wounds (www.plasticsurgery.org).
- Simple repair is used when the wound is superficial; e.g. involving primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures, and requires simple one layer closure. This includes local anesthesia and chemical or electrocauterization of wounds not closed.
- Intermediate repair includes the repair of wounds that, in addition to the above, require layered closure of one or more of the deeper layers of subcutaneous tissue and superficial (non-muscle) fascia, in addition to the skin (epidermal and dermal) closure. It includes limited undermining (defined as a distance less than the maximum width of the defect, measured perpendicular to the closure line, along at least one entire edge of the defect). Single-layer closure of heavily contaminated wounds that have required extensive cleaning or removal of particulate matter also constitutes intermediate repair.
- Complex repair includes the repair of wounds that, in addition to the requirements for intermediate repair, require at least one of the following: exposure of bone, cartilage, tendon, or named neurovascular structure; debridement of wound edges (e.g. traumatic lacerations or avulsions), extensive undermining (defined as a distance greater than or equal to the maximum width of the defect, measured perpendicular to the closure line along at least on entire edge of defect); involvement of free margins of helical rim, vermilion border, or nostril rim; placement of retention sutures. Necessary preparation includes the creation of a limited defect for repairs or the debridement of complicated lacerations or avulsions. Complex repair does not include excision of benign (11400-11446) or malignant (11600-11646) lesions, excisional preparation of a wound bed (15002-15005) or debridement of an open fracture or open dislocation.
Navigating code changes and billing guidelines for any specialty is easier with the help of an experienced medical billing service provider. Teams in reliable medical billing companies stay up to date with these changes and can help providers submit error-free claims to ensure faster and correct reimbursement.