General Surgery Coding Alert

Look for drug-delivery device additions.

We’re rounding up all the procedure-code changes you need to know for your general surgery practice next year. CPT^® 2020 goes into effect on Jan. 1 and now is the time to prepare. 

After last month’s discussion of chest wall tumor codes that moved from the CPT^® Integumentary section to the Musculoskeletal section, we’ve identified a few more 20000-level codes you need to know.

Look for Stepwise Drug Delivery Service

You may already use existing CPT^® codes when your surgeon places or removes non-biodegradable drug delivery implants, but don’t confuse those procedures with services described by the following new codes for drug delivery devices:

• +20700 (Manual preparation and insertion of drug-delivery device(s), deep (eg, subfascial) (List separately in addition to code for primary procedure)
• +20701 (Removal of drug-delivery device(s), deep (eg, subfascial) (List separately in addition to code for primary procedure)
• +20702 (Manual preparation and insertion of drug-delivery device(s), intramedullary (List separately in addition to code for primary procedure)
• +20703 (Removal of drug-delivery device(s), intramedullary (List separately in addition to code for primary procedure)
• +20704 (Manual preparation and insertion of drug-delivery device(s), intra-articular (List separately in addition to code for primary procedure)
• +20705 (Removal of drug-delivery device(s), intra-articular (List separately in addition to code for primary procedure)

The placement codes in this series include “manual preparation,” which CPT^® defines as “mixing and preparation of … therapeutic agent(s) with a carrier substance … during the surgical procedure and then shaping the mixture into a drug-delivery device(s)(e.g. beads, nails, spacers) ….” The section introduction further states, “Insertion of a prefabricated drug device(s) may not be reported with +20700, +20702, +20704.”

Plus: These are all add-on codes, and CPT^® provides a list of primary codes with which you can report each new procedure code.

Restrictions: In addition to listing the primary codes, CPT^® also provides a list of existing code(s) that you should not report together with each new code. “These code restrictions are primarily the existing drug-delivery device codes,” says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, national director of marketing and revenue management at FasPsych in Omaha, Nebr.

Keep a lookout for the following codes that CPT^® may bundle with one or more of the new codes:

• 11981 (Insertion, non-biodegradable drug delivery implant)
• 11982 (Removal, non-biodegradable drug delivery implant)
• 11983 (Removal with reinsertion, non-biodegradable drug delivery implant)
• 96522 (Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic (eg, intravenous, intra-arterial))
• Use this code for systemic drug therapy such as chemotherapy
• 95990-95991 (Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed …)
• 62367-62370 (Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status) …)

Tip: If your surgeon removes these device(s) as a separate procedure apart from any associated primary procedure, you should not use one of the new removal codes, but should instead report 20680 (Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)). 

Unit of service: You should report +27000-+20705 once per anatomic location.

Check Out New Dry Needling Code

If your surgeon performs dry needling procedures, you’ll find two new codes for the service in CPT^® 2020. The new codes break down by muscle group(s) involved in the procedure, as follows:

• 20560 (Needle insertion(s) without injection(s); 1 or 2 muscle(s))
• 20561 (… 3 or more muscles)

Caution: Be careful not to confuse dry needling with trigger point injections or acupuncture,” advises Sarah L. Goodman, MBA, CHCAF, COC, CCP, FCS, president and CEO of SLG, Inc. Consulting in Raleigh, North Carolina. “With dry needling, no medication is administered via the needle,” Goodman explains.