In December, my IMO colleagues and I hosted a webinar about the CPT 2020 updates where we discuss details of many of the 248 additions, 71 deletions, and 75 revisions that took effect on January 1. While these details are critical to ensuring that healthcare providers are prepared for the coding changes, the annual updates are also a time to look at the larger picture of healthcare and see how these modifications reflect the current medical landscape.
Since medical knowledge is always evolving, it’s important to have a code system that can grow along with it. With CPT, the annual review and update process is our industry’s way of making sure medical procedure codes continue to support the needs of healthcare providers. These updates ensure the system is streamlined and usable, whether through pure guideline changes or by adding new information about different procedures as we learn more about them.
Clarifying wound distinctions
This year, there are a few examples of simple, but helpful, guideline changes. One such change helps clarify coding for intermediate versus complex wound repair. Prior to 2020, complex repair was distinguished from intermediate repair. The distinction was made by including layered closure in the definition of intermediate repair, along with:
- Repairs for scar revision
- Extensive undermining
- Use of stents or retention sutures
- Preparation that included the creation of a limited defect for repairs or the debridement of complicated lacerations or avulsions
With all of these distinct situations combined into one definition, it was determined that a more robust set of codes was needed to distinguish intermediate wound repairs from complex ones.
For 2020, the revised guidelines clarify that intermediate repair includes limited undermining. Guidelines further clarify that complex repair includes the requirements listed for intermediate repair and at least one of the following:
- Exposure of bone, cartilage, tendon or named neurovascular structure
- Debridement of wound edges
- Extensive undermining
- Involvement of free margins of helical rim
- Vermilion border
- Nostril rim and placement of retention sutures
- Illustration of extensive undermining
The previous reference to scar revision and stents has been removed. These clarifications assist the healthcare provider with selecting the appropriate code for the procedure performed and help ensure clarity about the injury within the patient’s chart.
Providing greater specificity
Code updates are also important to help providers report the appropriate CPT code for the procedure being performed. A common example of this is site specificity. This year, the new codes for chest wall tumor support the changes in the breast and respiratory sections. This added specificity helps modernize CPT subsections to better reflect current clinical practice. Specifically, these codes address the difference between lipoma and lesion. Removal of lipoma is deeper, and would lead to the Musculoskeletal versus Integumentary. These new codes are specific to chest wall and not breasts.
The key piece, though, to all CPT updates is that the annual changes to the codes allow the classification system to keep up with major changes in procedures. In 2020, we see this with code 33860, formerly ascending aortic graft, including valve suspension. This code was removed and replaced with two new codes, 33858 and 33859, which help providers identify the diagnostic information of why the procedure was performed when capturing the procedure in the chart. Code 33858 now identifies just an aortic dissection, while code 33859 should be used for all other aortic diseases.
While some of the changes mentioned above, and discussed at length in the webinar, may seem minor, they are critical to the evolution and improvement of CPT. The ability to document and communicate with greater specificity empowers all of us to be better at our jobs, which ultimately leads to better patient care.
Shelly Jude is a Senior Mapping Specialist and Terminologist at IMO. She specializes in the Current Procedural Terminology (CPT) codes and is a Registered Health Information Technician (RHIT). She resides in Columbus, OH, and has been part of the IMO team for nearly seven years.
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