This blog typically consists of the coding changes pertaining to the musculoskeletal system. There are 11 new codes added to the musculoskeletal system.

Total number of new codes: 11 new codes

a) Two new codes to report needle insertion into the muscle.

· 20560

· 20561

b) Six new codes to report manual preparation and insertion of drug delivery devices and the removal of the devices.

· 20700

· 20701

· 20702

· 20703

· 20704

· 20705

c) Three new codes to report excision of chest wall tumor.

· 21601

· 21602

· 21603

1. Needle Insertion without Injection: (Dry Needling)

Dry needling refers to a procedure in which a fine needle is inserted into the skin and muscle at a site of myofascial pain. It may be performed with acupuncture needles or standard hypodermic needles, but is performed without the injection of medications (e.g., anesthetics, corticosteroids).

Earlier we do not have specific CPT codes for dry needling procedures. Therefore coders used CPT 97140(Intramuscular manual therapy) and few others used CPT 20999 (Unlisted procedure, musculoskeletal system,). To overcome this issue, two specific CPT codes for dry needling have been introduced in 2020 as below:

  • 20560: Needle insertion(s) without injection(s), 1 or 2 muscle(s)
  • 20561: Needle insertion(s) without injection(s), 3 or more muscle(s)

Points to remember when coding 20560 and 20561:

a) These procedure codes are based on the number of muscles being treated.

b) The number of needles used, and time spent with the patient is not taken into consideration when determining the appropriate code to use.

c) Only one unit of this code can be billed per encounter.

d) These codes should not be used if any medications are injected into the muscle.

2. Insertion of Drug Delivery Devices: 20700-20705

New add-on codes 20700-20705 describe “manual preparation and insertion of implants designed to deliver drugs such as antibiotics to deep musculoskeletal spaces.” These codes are categorized based on two factors as below:

· Type of service rendered ( either insertion or removal of drug-delivery device)

· Region where the device is inserted ( deep, intramedullary, or intra-articular)

Please refer the new add-on codes as shown below:

New add-on codesNew add-on codes

.Points to remember:

a) These are add-on codes which are always reported in conjunction with other procedures.

b) Manual mixing is a key element in choosing these add-on codes. It involves mixing and preparation of antibiotics or other therapeutic agents during the surgical procedure. The provider then shapes that mixture into the drug delivery device.

c) Per the guidelines, each of these add-on codes may be reported once per anatomic location.

Note: Coders should be cautious in selecting the drug delivery device codes as it should not be confused with the subcutaneous implant code sets.

Subcutaneous implants: ( 11981-11983)

A subcutaneous implant, or subcutaneous pellet, is an implant that is delivered under the skin into the subcutaneous tissue by surgery or injection and is used to deliver a drug for a long period of time.

Difference between 11981-11983 and 20700-20705:

Difference between 11981-11983 and 20700-20705Difference between 11981-11983 and 20700-20705

3. Chest Wall tumor Excision codes:

Three new codes were added for the excision of chest wall tumors:

a) 21601: Excision of chest wall tumor including rib(s)

b) 21602: Excision of chest wall tumor involving rib(s), with plastic reconstruction; without mediastinal lymphadenectomy

c) 21603: with mediastinal lymphadenectomy

The codes 19260, 19271 and 19272 from the Integumentary system are deleted and replaced with new codes 21601, 21602 and 21603 respectively.

Note: “The information provided in this article is valid at the time of posting and may subject to change every year.”

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