CPT 2018 Changes for Orthopaedic Surgery: It’s all about that Spine……almost
By Heidi Stout, CPC, COSC, CCS-P
Not much will change for orthopaedic surgery coding in 2018. Most of the changes in CPT 2018 to the Musculoskeletal System codes (20005-29999) and Nervous System- Spine And Spinal Cord codes from 2017, including additions, deletions, and revisions, impact the reporting of orthopaedic spinal procedures. Only one new code has been added and two have been deleted. A number of instructional notes have been added to clarify proper reporting of certain codes.
Here are the noteworthy changes:
CPT code 20225-Biopsy, bone, trocar, or needle; deep (eg, vertebral body, femur)
- A new instruction note has been added: “For bone marrow biopsy(ies) and/or aspiration(s), see 38220, 38221, 28222”.
Injection or Removal (CPT codes 20500-20664)
- A new instructional note has been added: “For injection of autologous adipose-derived regenerative cells, see 0489T, 0490T”.
Grafts (or Implants) (CPT codes 20900-20939)
- A new instructional note has been added: “Codes for obtaining autogenous bone, cartilage, tendon, fascia lata grafts, bone marrow, or other tissues through separate skin/fascial incision should be reported separately, unless the code descriptor references the harvesting of the graft or implant (eg, includes obtaining graft)”.
CPT code 20926- Tissue grafts, other (eg, paratenon, fat, dermis)
- New instructional notes have been added: “Do not report code 20692 in conjunction with 0489T, 0490T”, “For harvesting of adipose tissue for autologous adipose-derived regenerative cell therapy, see 0489T, 0490T”, “For injection of autologous adipose-derived regenerative cells, see 0489T, 0490T”, “For harvesting, preparation, and injection(s) of platelet-rich plasma, use 0232T”.
CPT code 20938- Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision) (List separately in addition to code for primary procedure)
- A new instructional note has been added: “For bone marrow aspiration for bone grafting, spine surgery only, use 20939”.
New CPT code 20939 has been added with instructional notes
- 20939- Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision (List separately in addition to code for primary procedure)
- “Use 20939 in conjunction with 22319, 22532, 22533, 22534, 22548, 22551, 22552, 22554, 22556, 22558, 22590, 22595, 22600, 22610, 22612, 22630, 22633, 22634, 22800, 22802, 22804, 22808, 22810, 22812”
- “For bilateral procedure, use 20939 with modifier 50”
- “For aspiration of bone marrow for the purpose of bone grafting, other than spine surgery and other therapeutic musculoskeletal applications, use 20999”
- “For bone marrow aspiration(s) for platelet-rich stem cell injection, use 0232T”
- “For diagnostic bone marrow aspiration(s), see 38220, 38222”
Application of Casts and Strapping
- A new instructional note has been added: “For orthotics management and training, see 97760, 97761, 97763”
CPT code 29540-Strapping; ankle and/or foot
- An instructional note has been revised: “Do not report code 29540 in conjunction with 29581”
CPT code 29580- Strapping; Unna boot
- An instructional note has been revised: “Do not report code 29580 in conjunction with 29581”
CPT code 29581- Application of multi-layer compression system; leg (below knee), including ankle and foot
- An instructional note has been revised: “Do not report code 29581 in conjunction with 29540, 29580, 36468, 36470, 36471, 36475, 36476, 36478, 36479”
CPT codes 29582 and 29583 have been deleted
- 29582- Application of multi-layer compression system; thigh and leg, including ankle and foot, when performed
- 29583- Application of multi-layer compression system; upper arm and forearm
Anterior or Anterolateral Approach for Extradural Exploration/Decompression
- An instructional note has been added: “For vertebral corpectomy, the term partial is used to describe removal of a substantial portion of the body of the vertebra. In the cervical spine, the amount of bone removed is defined as at least one-half of the vertebral body. In the thoracic and lumbar spine, the amount of bone removed is defined as at least one-third of the vertebral body.”
Lateral Extracavitary Approach for Extradural Exploration/Decompression
- An instructional note has been added: “For vertebral corpectomy, the term partial is used to describe removal of a substantial portion of the body of the vertebra. In the cervical spine, the amount of bone removed is defined as at least one-half of the vertebral body. In the thoracic and lumbar spine, the amount of bone removed is defined as at least one-third of the vertebral body.”
Excision, Anterior or Anterolateral Approach, Intraspinal Lesion
- An instructional note has been added: “For vertebral corpectomy, the term partial is used to describe removal of a substantial portion of the body of the vertebra. In the cervical spine, the amount of bone removed is defined as at least one-half of the vertebral body. In the thoracic and lumbar spine, the amount of bone removed is defined as at least one-third of the vertebral body.”
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