AAOS Now

Published 11/30/2019
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Joanne Willer

2020: New Year Means New Codes for Drug-delivery Implant Devices and More

Each year, the American Medical Association (AMA) provides coding and guideline changes to the Current Procedural Terminology (CPT) Manual. This article summarizes the relevant changes to the musculoskeletal section for 2020. For a full summary of the additions, deletions, and revisions, refer to Appendix B of the CPT Manual.

What you need to know …

Six new add-on codes describing insertion and removal of drug-delivery implant devices specific to musculoskeletal treatments have been added to the CPT code set for 2020. The new codes were created to differentiate between the existing codes (which are in the integumentary section of CPT 11981–11983) and orthopaedic procedures for the treatment of soft tissue-, bone-, and joint-related infections. The new codes are for insertion, removal, and removal with reinsertion of nonbiodegradable drug-delivery implants. Multiple specialties have been using the existing codes, which lack specificity, and that was the catalyst for change.

The new codes and their descriptors are:

  • 20700: manual preparation and insertion of drug-delivery device(s), deep (e.g., subfascial) (List separately in addition to code for primary procedure.)
  • 20701: removal of drug-delivery device(s), deep (e.g., 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.)

Codes 20700, 20701, and 20702 are add-ons to be reported for the manual preparation and insertion of a drug-
delivery device during the associated primary surgical procedure. The primary procedures are included as instructional parenthetical notes following the codes and include a range of procedures from the 11000 and 20000 code series.

Codes 20703, 20704, and 20705 are add-ons to be reported for the removal of the drug-delivery device(s) during the associated primary surgical procedure. Again, one must refer to the instructional parenthetical notes in the CPT Manual for the list of associated primary surgical procedures.

Codes 20700, 20702, and 20704 cannot be reported in conjunction with code 11981, whereas codes 20701, 20703, and 20705 cannot be reported with code 11982. If the only procedure is the removal of the drug-delivery device(s), then code 20680 should be reported because the new codes are add-ons and must be reported with a primary procedure.

AAOS Now will further expand on the codes and provide examples of each in an article to be published early 2020. Additionally, new guidelines describing manual preparation have been added to the Introduction and Removal subsection of the CPT Manual. Those guidelines can be found preceding code 20697.

CPT code 20926, Tissue grafts, other (e.g., paratenon, fat, dermis), has been deleted for 2020. That code was identified as potentially misvalued by the AMA Relative Value Scale Update Committee Relativity Assessment Workgroup (RAW). RAW determined that the code was being used for significantly different procedures, such as small soft-tissue grafts, correction of minor contour deformities, and placement into a defect for reconstructive purposes.

In the absence of code 20926, five new codes have been created to report those services. New guidelines regarding the codes can be found in the Other Flaps and Grafts subsection of the CPT Manual. The new codes are as follows:

  • 15769: grafting of autologous soft tissue, other, harvested by direct excision (e.g., 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: each additional 50 cc injectate, or part thereof (List separately in addition to code for primary procedure.)
  • 15773: grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate
  • 15774: each additional 25 cc injectate, or part thereof (List separately in addition to code for primary procedure.)

Lastly, several changes were made to codes within the Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System section of the CPT Manual, including revised code descriptors to the 64400–64450 series of codes; instructional parenthetical notes; and deletion of codes 64402, 64410, and 64413.

Joanne Willer is the manager of coding and reimbursement resources in the AAOS Office of Government Relations.