2018 CPT Changes for Orthopaedic Surgery

January 2018 ~

This year, CPT^® coding updates for orthopaedic surgery includes the removal of two codes and adds one new code, as well as a number of instructional notes to clarify proper reporting of certain codes.

The following code changes will apply to orthopaedic surgery in 2018:

New Codes

• 20225 – Biopsy, bone, trocar, or needle; deep (e.g., vertebral body, femur)
  • A new instruction note has been added: “For bone marrow biopsy(ies) and/or aspiration(s), see 38220, 38221, 28222”.
• 20500-20664 – Injection or Removal
  • A new instructional note has been added: “For injection of autologous adipose-derived regenerative cells, see 0489T, 0490T”.
• 20900-20939 – Grafts (or Implants)
  • 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)”.
• 20926 – Tissue grafts, other (e.g., 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”.
• 20938 – Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision)
  • A new instructional note has been added: “For bone marrow aspiration for bone grafting, spine surgery only, use 20939”.
• 20939 – Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision
  • “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”
• 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.”

Revised Codes

• 29540 – Strapping; ankle and/or foot
  • An instructional note has been revised: “Do not report code 29540 in conjunction with 29581.”
• 29580 – Strapping; Unna boot
  • An instructional note has been revised: “Do not report code 29580 in conjunction with 29581.”
• 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.”

Deleted Codes

• 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.

CPT^® is a registered trademark of the American Medical Association.

Source(s): The Coding Network; Libman Education;