September 2019 Coding Updates

September 2019 Coding Updates

Intermediate and Complex Repairs

The descriptions for intermediate and complex repairs have been clarified
including adding the description for limited and extensive undermining.

Intermediate Repair- 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- 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 the distance greater than or
equal to the maximum width of the defect, measured perpendicular to the
closure line along at least one entire edge of the defect); involvement of free
margins of helical rim, vermillion border, or nostril rim; placement of
retention sutures. Necessary preparation includes creation of a limited
defect for repairs or the debridement of complicated lacerations or avulsions

Scar revision has been removed from the description of complex repair.
Per the AMA, Scar revision in which skin is excised and closure is
performed should be coded as excision of benign lesion. This code will be
considered included in most other surgical procedures.

Dry Needling

20560- needle insertion(s), without injection, single or multiple trigger
point(s), 1 or 2 muscle(s)
20561- 3 or more muscles
No medication, so cannot be called an injection
Cannot be considered acupuncture because not all elements are performed
Coded by muscle group similar to 20552-20553
Cannot be reported with 20552-20553

Drug Delivery Device

Codes to replace 11981-11983 in Orthopaedics
Add on codes
Removal of drug delivery device alone is reported as 20680
Only billed once per anatomic site
Cannot be used for articulating, out of the box devices. Must be manually manufactured.

20700- manual preparation and insertion of drug delivery device(s), deep (subfascial)
20702- manual preparation and insertion of drug delivery device(s), intramedullary (within bone)
20704- manual preparation and insertion of drug delivery device(s), intra-articular (within joint)
20701- removal of drug delivery device(s), deep (subfascial)
20703- removal of drug delivery device(s), intramedullary (within bone)
20705- removal of drug delivery device(s), intra-articular (within joint)
Examples

• Removal of implant and placement of manually manufactured, non-articulating device
  • Hip: 27090 or 27091 (spacer included in code description)
  • Knee 27488 with 20704
• Infected total hip or knee, first stage, out of box implant
  • Hip- 27134
  • Hemiarthoplasty- 27090,27091, or 27125
  • Knee- 27487
• Second stage revision, manually manufactured (20704) removed, and new prosthesis inserted
  • Hip- 27132 and 20705
  • Knee- 27447-22 and 20705 (because there is no conversion code)
• Second stage revision, out of box removed, and new prosthesis inserted
  • Hip- 27134
  • Knee-27487

Somatic Nerve Injections

64451- nerves innervating the sacroiliac joint, with image guidance (i.e.. fluoroscopy or CT)

• All levels included 64451

64454- genicular nerve branches, including imaging guidance, when performed

• If all 3 nerves, superolateral, superomedial, and inferomedial, are not injected, report modifier 52

Radiofrequency Ablation

64624 Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed
64625 Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy
or computed tomography)

Modifier 50 can no longer be applied to add on codes. Bilateral procedures represented by add on codes
will have to be reported by quantity.