1. Revision of Wound repair description.
Wound repair codes exist as an important topic in the Integumentary system. The factors that the coder needs to take into account when coding for wound repair are the anatomic site, the length of the wound and the type of repair. We all know that there are three types of wound repair listed as below:
1. Simple repair
2. Intermediate repair
3. Complex repair.
The definition for simple repair remains unchanged. However the guidelines have been revised for both the Intermediate and complex repair.
Intermediate repair 🙁 definition changes are highlighted in bold)
In 2019, the intermediate repair is defined as the wound requiring layered closure of one or more of the deeper layers of subcutaneous tissue and superficial fascia, and skin closure or requiring single-layer closure of a heavily contaminated wound that required extensive cleaning or removal of particulate matter.
However in 2020, the definition has changed with the addition of new language” Limited undermining”.
Per 2020 code changes, the intermediate repair is defined as the wound requiring Limited undermining and layered closure of subcutaneous tissue and/or superficial fascia and skin closure or requiring single-layer closure of a heavily contaminated wound that required extensive cleaning or removal of particulate matter.
CPT describes limited undermining 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.”
Complex repair 🙁 definition changes are highlighted in bold)
In 2019, complex repair is defined as the wound requiring more than layered closure, viz., scar revision, debridement (eg, traumatic lacerations or avulsions), extensive undermining, stents or retention sutures. Necessary preparation includes creation of a limited defect for repairs or the debridement of complicated lacerations or avulsions.
In 2020, several elements have been added to constitute the definition of complex repair. As of January 1, 2020, complex repair requires all three of the following:
· Meeting one of the two criteria of intermediate repair.
· Preparation of the wound performed by either creation of a limited defect for repairs or the debridement of complicated lacerations or avulsions
· One of the following:
1) exposure of bone, cartilage, tendon, or named neurovascular structure
2) debridement of wound edges
3) extensive undermining
4) involvement of free margins of the helical rim, vermilion border, or nostril rim
5) placement of retention sutures
CPT describes extensive undermining as “a 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”.
2. New graft codes: (15769 – 15774)
For 2020, code 20926 will be deleted and replaced with five new codes (15769-15774) in the Integumentary system, other flaps and grafts subsection.
Deleted code: 20926; Tissue grafts, other ( eg. paratenon, fat, dermis)
New codes: 15769, 15771, 15772, 15773, 15774
CPT 15769 – Autologous soft tissue harvest by direct excision.
This new code is reported for autologous soft tissue harvested by direct excision technique. Autologous means the grafts are obtained from the same individual who then receives the grafts.
Coders must apply 15769 when both the grafts placing into the defect and harvesting of the graft should occur during the same operation.
CPT 15771-15774 – Autologous fat harvested by liposuction.
This new code is reported for grafting of autologous fat harvested by liposuction technique. In these procedures, the fat cells or the adipose cells are harvested by liposuction technique and then injected via cannula in multiple small aliquots to the defect.
As the codes are classified based on the anatomic sites and volume of the injectate, coders must definitely know the process involved in the technique to select the appropriate code set.
Step: 1: Harvest – Usually the fatty tissue is harvested from donor sites like abdomen, the inner thighs and the fat on the outer thigh using liposuction techniques.
Step: 2: Centrifuge – Next, centrifuge the fatty tissue to separate it into three layers: the oil (fatty acids), the pure fat (which will be injected to the required area) and the blood located in the lower section.
Step: 3: Isolation – It is the process of separating the pure fat from the other layers.
Step: 4: Implantation – In the final step, the fat is re-injected in small droplets throughout the subcutaneous tissue of the recipient area. The amount of fat which is referred to as “Injectate” in the code sets are usually measured in cc’s.
CPT code 15771-15774 selection is based on the two factors:
1) Body part or parts where the grafts are placed (recipient site) and
2) The volume of the injectate measured in cc.
Recipient site: Coders should not confuse the term between recipient and donor site. The body parts listed, such as “trunk, breasts, scalp, arms, and/or legs” in 15771, are the recipient sites of the graft and not the donor site.
Volume: This refers to the total amount of injectate (fat cells) being injected to the defect. For multiple sites of injection, sum the total volume of injectate to anatomic sites that are grouped together into the same code descriptor.
15769 Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia)
15771 Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms and/or legs; 50 cc or less injectate
15772 Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms and/or legs; each additional 50 cc injectate, or part thereof (List separately in addition to code for primary procedure)
(Use 15772 in conjunction with 15771)
15773 Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears orbits, genialia, hands and/or feet; 25 cc or less injectate
15774 Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears orbits, genialia, hands and/or feet; each additional 25 cc injectate, or part thereof (List separately in addition to code for primary procedure)
(Use 15774 in conjunction with 15773)
3. Excision of chest wall tumor codes:
In 2019, CPT codes 19260, 19271 and 19272 describing the radical resection of a chest wall tumor involving and/or including rib(s), were placed in the Integumentary system, Breast subsection.
However In 2020, the following change has taken place:
CPT 19260, 19271 and 19272 are deleted from the Integumentary system, Breast subsection and replaced with New CPT codes 21601, 21602 and 21603. These new codes are placed into the Musculoskeletal system.
Deleted CPT codes from Integumentary system:
19260: Excision of chest wall tumor including ribs
19271: Excision of chest wall tumor involving ribs, with plastic reconstruction; without mediastinal lymphadenectomy
19272: Excision of chest wall tumor involving ribs, with plastic reconstruction; with mediastinal lymphadenectomy
New CPT codes placed into Musculoskeletal system:
21601: Excision of chest wall tumor including rib(s)
21602: Excision of chest wall tumor involving rib(s), with plastic reconstruction; without mediastinal lymphadenectomy
21603: Excision of chest wall tumor involving rib(s), with plastic reconstruction; with mediastinal lymphadenectomy
4. Changes in the Breast guidelines:
The following changes have been taken place in the breast section:
1) “Incision” and “Excision” subheadings will be deleted from the CPT Integumentary System, Breast subsection.
2) Extensive revision is done to report percutaneous and image-guided breast biopsy, open incisional breast biopsy, and open excision of a breast lesion.
3) Extensive revision is done to report percutaneous image-guided placement of breast localization device(s).
4) CPT 19304 ( Mastectomy, subcutaneous) is deleted for 2020.
5) New instructional parentheticals were added to report CPT 19300 and CPT 19318.
“The information provided in this article is valid at the time of posting and may subject to change every year. “.