The American Medical Association (AMA) announced the release of the 2021 Current Procedural Terminology (CPT®) code set containing identifiers and descriptors assigned to each medical, surgical, and diagnostic services available to patients. Trusted since 1966 as the health system’s common language, the CPT code set enables accurate reporting, measurement, analysis, and benchmarking of medical services and procedures across the nation’s entire health care system. There are 394 code changes in the 2021 CPT code set, including 248 new codes, 71 deletions, and 75 revisions. Outlined below are the sections and codes that will have the biggest impact on Ambulatory Surgery Centers.
New Codes: Specific codes have been created for both genicular nerve and sacroiliac joint nerve procedures with comprehensive directives by the AMA listed within the parentheticals of these codes.
- CPT 64454 – Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed (Do not report 64624 in conjunction with 64454). (Do not report 64454 in conjunction with 64624). (64454 requires injecting all of the following genicular nerve branches: superolateral, superomedial, and inferomedial. If all 3 of these genicular nerve branches are not injected, report 64454 with modifier 52).
- CPT 64624 – Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed (Do not report 64624 in conjunction with 64454.) (64624 requires the destruction of each of the following genicular nerve branches: superolateral, superomedial, and inferomedial. If a neurolytic agent for the purposes of destruction is not applied to all of these nerve branches, report 64624 with modifier 52.)
- CPT 64451 – Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography) (For injection, anesthetic agent, nerves innervating the sacroiliac joint, use 64451.) (Do not report 64451 in conjunction with 64493, 64494, 64495, 77002, 77012, 95873, 95874.) (For injection, anesthetic agent, nerves innervating the sacroiliac joint, with ultrasound, use 76999.)
- CPT 64625 – Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography) (Do not report 64625 in conjunction with, 64636, 77002, 77003, 77012, 95873, 95874.) (For radiofrequency ablation, nerves innervating the sacroiliac joint, with ultrasound, use 76999.)
- CPT 62328 – Spinal puncture, lumbar, diagnostic
- CPT 62329 – Spinal puncture, lumbar, therapeutic
New codes: Grafting codes have been added to provide greater detail describing different tissue-grafting procedures.
- CPT 15769 – Grafting of autologous soft tissue, other, harvested by direction excision (eg, fat, dermis, fascia)
- CPT 15771 – Grafting of autologous fast harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; 50cc or less injectate
- CPT 15773 – Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 ccs or less injectate
- CPT 20926 – Tissue grafts, other (eg, paratenon, fat, dermis
- CPT 19304 – Mastectomy, Subcutaneous
Eye & Occular Adnexa
New Codes: A new cataract technique has been added to the eye section.
- CPT 66987– Complex cataract with endoscopic cyclophotocoagulation
- CPT 66988 – Cataract with endoscopic cyclophotocoagulation
- CPTs 66982 and 66984 – now includes in the description “without endoscopic cyclophotocoagulation”
- CPT 46948 – Hemorrhoidectomy, internal, by transanal hemorrhoidal dearterialization, 2 or more groups
- CPT 0249T – Hemorrhoidectomy, internal, by transanal hemorrhoidal dearterialization, 2 or more groups
It can be a tedious task to search through all updates each year and an even more challenging task to try to pull out information that is relevant to ASCs. It may seem overwhelming; however, it is necessary to ensure accurate and compliant coding for your surgery center. To prevent an increase in denials in 2021, educating your billing department on all the code changes is recommended. Routine audits are a good way to safeguard your surgery center throughout the year.