Updates in Integumentary and Musculoskeletal coding
The year 2016 brings just two new Integumentary codes and deletes a single Musculoskeletal code, within the Surgery section of CPT(R). These are very small changes to overlook, but are costly to ignore.
Integumentary Updates
CPT(R) adds two codes to describe placement of these devices:
- 10035 Placement of soft tissue localization device(s) (Eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; first lesion
- +10036 each additional lesion (List separately in addition to code for primary procedure)
10035 and +10036 should be reported per lesion, not per marker (several markers may be placed per lesion). 10035 should be reported for placement of soft tissue markers at an initial lesion and +10036 for each additional lesion targeted beyond the first.
Note that CPT(R) includes several codes that specifically describe placement of localization devices in the breast, either with (19081-19086) or without (19281-19288) biopsy. CPT(R) Changes 2016 clarifies, ?10035 and 10036 have been established to capture marker placements into areas such as the axilla and/or groin tissue.?10035/10036 should not be reported if 19081-19086 or 19281-19288 better describes the location of the marker.
. There is no need to separately report as marker placement includes imaging guidance:
- 76942 Ultrasonic guidance for needle placement (Eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation
- 77002 Fluoroscopic guidance for needle placement (Eg, biopsy, aspiration, injection, localization device)
- 77012 Computed tomography guidance for needle placement (Eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation
- 77021 Magnetic resonance guidance for needle placement (Eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation
There are no guidelines or parenthetical instruction revisions in the Integumentary chapter for 2016.
Another change to be noted is Code 21805, which previously described open treatment of rib fracture without fixation, is deleted for 2016 as an ?obsolete service.
In current practice, when an injured rib is treated in an open fashion, it is either resected or treated with some form of internal fixation CPT(R) Changes 2016 explains. Because existing codes for open rib fixation and codes for rib excision (21600) may be used to identify open rib treatments, code 21805 has been deleted without replacement.
Instruction in the CPT(R) codebook tells us to report 21899 Unlisted procedure, neck or thorax for external rib fixation. CPT(R) further directs us to report an evaluation and management (E/M) service for closed treatment of an uncomplicated rib fracture (e.g., the fracture is reduced without surgical intervention).
There are no guidelines or parenthetical instruction revisions in the Musculoskeletal chapter for 2016.