Examine Integumentary and Musculoskeletal Coding Changes

Examine Integumentary and Musculoskeletal Coding Changes

Overlooking minor changes can be a costly mistake.

Within the Surgery section of CPT®, the new year brings just two new Integumentary codes, and deletes a single Musculoskeletal code. Minor changes such as these are easy to overlook, but costly to ignore.

Integumentary Updates

Fiducial markers serve as radiologic landmarks. Using imaging guidance, each marker is placed in or near a tumor and becomes the “target” to facilitate precise delivery of radiation treatments. CPT® 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)

Report 10035 and +10036 per lesion, not per marker (several markers may be placed per lesion). Claim 10035 for placement of soft tissue markers at an initial lesion and +10036 for each additional lesion targeted beyond the first.

The American Medical Association’s (AMA) CPT® Changes 2016: An Insider’s View provides an example of proper application for 10035:

A 62-year-old female presents with previously biopsied left axillary lymph node metastases secondary to invasive ductal breast carcinoma. She is now referred for neoadjuvant chemotherapy. Marking of the positive lymph node is requested prior to the initiation of neoadjuvant chemotherapy.

Note that CPT® includes several codes that specifically describe placement of localization devices in the breast, either with (19081-19086) or without (19281-19288) biopsy. CPT® Changes 2016 clarifies, “10035 and 10036 have been established to capture marker placements into areas such as the axilla and/or groin tissue.” Do not report 10035/10036 if 19081-19086 or 19281-19288 better describe the location of the marker.

Per CPT® Assistant (May 2015):

To report bilateral image-guided breast biopsies, report code 19081, 19083, or 19085 [depending on the type of imaging used; e.g., stereotactic, ultrasound, or MRI] for the initial biopsy. The contralateral image-guided breast biopsy and each additional image-guided breast biopsy are then reported with code 19082, 19084, or 19086. Similarly, to report bilateral marker placement, report code 19281, 19283, or 19285 [again, depending on the type of imaging used] for the initial marker placement. The contralateral and each additional breast image-guided marker placement are then reported with code 19282, 19284, or 19286.

Marker placement includes imaging guidance. Do not separately report:

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 guideline or parenthetical instruction revisions in the Integumentary chapter for 2016.

Open Treatment of Rib Fracture Is No Longer Supported

Code 21805, which previously described open treatment of rib fracture without fixation, is deleted for 2016 as an “obsolete service.” CPT® Changes 2016 explains, “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. 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® codebook tells us to report 21899 Unlisted procedure, neck or thorax for external rib fixation. CPT® 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). Turn to 21811-21813 for open (surgical) treatment of rib fracture(s) with internal fixation (the use of plates, screws, nails, and wires to stabilize the rib fracture).

There are no guideline or parenthetical instruction revisions in the Musculoskeletal chapter for 2016.


John Verhovshek, MA, CPC, is managing editor at AAPC and a member of the Hendersonville-Asheville, N.C., local chapter.

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John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

About Has 406 Posts

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

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