By Pamela Linton, CPC, CANPC
Corporate Coding Manager – Anesthesia and Pain Management
Provide descriptions of the new and revised CPT codes impacting Anesthesiology in 2020.
Please note: The description for each of the new or revised codes provides the full description of each code and includes any services “bundled” in newly bundled codes.
More detailed CPT instructions from various Medical Societies such as the ASA (which will assign ASA codes/base unit values) have yet to be published.This information is typically released around the second week of December.
New codes have been created for autologous soft tissue harvests:
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 inectate
+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)
Three codes have been deleted and replaced with new CPT codes in the musculoskeletal system below:
19260 Excision of chest wall tumor including ribs (To report, use 21601 – see below)
19271 Excision of chest wall tumor involving ribs, with plastic reconstruction; without mediastinal lymphadenectomy (To report, use 21602 – see below)
19272 Excision of chest wall tumor involving ribs, with plastic reconstruction; with mediastinal Lymphadenectomy (To report, use 21603 – see below)
The Musculoskeletal System has several new codes including replacement codes for three procedures previously reported with codes from Integumentary System.
20560Needle insertion(s) without injection(s); 1 or 2 muscle(s)
20561 Needle insertion(s) without injections; 3 or more muscles
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
The Respiratory System has some revised codes within the nasal endoscopy section.These revisions do not change the intent of the codes and are formatting changes only.There are no new or deleted codes in this section.
31233 Nasal/sinus endoscopy, diagnostic with maxillary sinuscopy (via inferior meatus or canine fossa puncture) with maxillary sinuscopy (via inferior meatus or canine fossa puncture)
31235 Nasal/sinus endoscopy, diagnostic with sphenoid sinuscopy (via puncture of sphenoidal face or cannulation of ostium) with sphenoid sinuscopy (via puncture of sphenoidal space or cannulation of ostium)
31292 Nasal/sinus endoscopy, surgical; with orbital decompression; with medial or inferior orbital wall decompression
31293 Nasal/sinus endoscopy, surgical with orbital decompression; with medial orbital wall and inferior orbital wall decompression
31295 Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); with dilation of maxillary sinus ostium, (eg, balloon dilation) transnasal or via canine fossa
31296 Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation) with dilation of frontal sinus ostium (eg, balloon dilation)
31297 Nasal/sinus endoscopy, surgical; with dilation (eg, balloon dilation); with dilation of sphenoid sinus ostium (eg, balloon dilation)
31298 Nasal/sinus endoscopy, surgical; with dilation (eg, balloon dilation); with dilation of frontal and sphenoid sinus ostia (eg, balloon dilation)
The Cardiovascular System received new codes for pericardiocentesis, tube pericardostomy, aortic graft procedures with cardiopulmonary bypass and vessel exploration codes.The old codes for these procedures have been deleted and are listed below:
33010 Pericardiocentesis; initial
33011 Pericardiocentesis; subsequent
33015 Tube pericardiostomy
33860 Ascending aorta graft, with cardiopulmonary bypass, includes valve suspension, when performed
33870 Transverse arch graft, with cardiopulmonary bypass
35721 Exploration (not followed by surgical repair), with or without lysis of artery; femoral artery
35741 Exploration (not followed by surgical repair), with or without lysis of artery; popliteal artery
35761 Exploration (not followed by surgical repair), with or without lysis of artery; popliteal artery
New CPT codes include replacement codes for the procedures listed above as well as a couple of new endovascular repair codes:
33016 Pericardiocentesis, including imaging guidance, when performed
33017 Pericardial drainage with insertion of indwelling catheter, percutaneous, including fluoroscopy and/or ultrasound guidance, when performed; 6 years and older without congenital cardiac anomaly
33018 Pericardial drainage with insertion of indwelling catheter, percutaneous, including fluoroscopy and/or ultrasound guidance, when performed; birth through five years of age or any age with congenital cardiac anomaly
33019 Pericardial drainage with insertion of indwelling catheter, percutaneous, including CT guidance
33858 Ascending aorta graft, with cardiopulmonary bypass, includes valve suspension, when performed; for aortic dissection
33859 Ascending aorta graft, with cardiopulmonary bypass, includes valve suspension, when performed; for aortic disease other than dissection (eg, aneurysm)
33871 Transverse aortic arch graft, with cardiopulmonary bypass, with profound hypothermia, total circulatory arrest and isolated cerebral perfusion with reimplantation of arch vessel(s) (eg, island pedicle or individual arch vessel reimplantation)
34718 Endovascular repair of iliac artery, not associated with placement an aorto-iliac arteryendograft at the same session, by deployment of an iliac branched endograft, include pre-procedure sizing and device selection, all ipsilateral selective iliac artery catheterization(s), all associated radiological supervision and interpretation, and all endograft extensions proximal to the aortic bifurcation and distally in the internal iliac, external iliac and common femoral artery(ies), and treatment zone angioplasty/stenting, when performed, for other than rupture (eg, for aneurysm, pseudoaneurysm, dissection, arteriovenous malformation, penetrating ulcer), unilateral
35702 Exploration not followed by surgical repair, artery; upper extremity (eg, axillary, brachial, radial, ulnar)
35703 Exploration not followed by surgical repair, artery; lower extremity (eg, common femoral, deep femoral, superficial femoral, popliteal, tibial peroneal)
There is one code revision in the cardiovascular section:
35701 Exploration (not followed by surgical repair), with or without lysis of artery; neck (eg, carotid, artery subclavian)
Changes to the digestive system include one deleted code, three revised codes and three new codes.
Deleted code:
43401 Transection of esophagus with repair, for esophageal varices
Note: There is not a replacement code for this procedure
Revised codes:
46945 Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group, without imaging guidance
46946 Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or more hemorrhoid columns/groups, without imaging guidance
New Codes:
46948 Hemorrhoidectomy, internal, by transanal hemorrhoidal dearterialization, 2 or more hemorrhoid columns/groups, include ultrasound guidance, with mucopexy, when performed
49013 Preperitoneal pelvic packing for hemorrhage associated with pelvic trauma, including local exploration
49014 Re-exploration of pelvic wound with removal of preperitoneal packing, including repacking, when performed
There is one revised code in the male genitalia section
54640 Orchiopexy, inguinal approach, with or without hernia repair or scrotal approach
There are several revised codes, three code deletions and six new codes in the nervous system.
Deleted codes:
64402 Injection, anesthetic agent; facial nerve – to report use CPT code 64999
64410 Injection, anesthetic agent; facial nerve – to report use CPT code 64999
64413 Injection, anesthetic agent; cervical plexus – to report use CPT code 64999
Code revisions:
62270 Spinal puncture, lumbar, diagnostic
62272 Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter)
64400 Injection(s), anesthetic agent (s) and/or steroids; trigeminal nerve, any division or branch each branch (i.e., ophthalmic, maxillary, mandibular)
64405 Injection, anesthetic agent(s) and/or steroids; greater occipital nerve
64408 Injection, anesthetic agent(s) and/or steroids; vagus nerve
64415 Injection, anesthetic agent(s) and/or steroids; brachial plexus, single
64416 Injection, anesthetic agent(s) and/or steroids; brachial plexus, continuous infusion by catheter (including catheter placement)
64417 Injection, anesthetic agent(s) and/or steroids; axillary nerve
64418 Injection, anesthetic agent(s) and/or steroids; suprascapular nerve
64420 Injection, anesthetic agent(s) and/or steroids; intercostal nerve, single level
+64421 Injection, anesthetic agent(s) and/or steroids; intercostal nerves, multiple, regional block each additional level (List separately in addition to code for primary procedure)
Note: This is now an add-on code and is reported with 64420
64425 Injection, anesthetic agent(s) and/or steroids; ilioinguinal, iliohypogastric nerves
64430 Injection, anesthetic agent(s) and/or steroids; pudendal nerve
64435 Injection, anesthetic agent(s) and/or steroids; paracervical (uterine) nerve
64445 Injection, anesthetic agent(s) and/or steroids; sciatic nerve, single
64446 Injection, anesthetic agent(s) and/or steroids; sciatic nerve, continuous infusion by catheter (including catheter placement)
64447 Injection, anesthetic agent(s) and/or steroids; femoral nerve, single
64448 Injection, anesthetic agent(s) and/or steroids; femoral nerve, continuous infusion by catheter (including catheter placement)
64449 Injection, anesthetic agent(s) and/or steroids; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement)
64450 Injection, anesthetic agent(s) and/or steroids; other peripheral nerve or branch
New Codes:
64451 Injection, anesthetic agent(s) and/or steroids; nerves innervating the sacroiliac joint, with image guidance (i.e., fluoroscopy or computed tomography)
Notes: For injection, anesthetic agent, nerves innervating the sacroiliac joint with ultrasound – use 76999.For bilateral procedure report with modifier 50.
64454 Injection, anesthetic agent(s) and/or steroids; genicular nerve branches, with image guidance, when performed
Note: 64454 requires injecting all of the following genicular nerve branches; superolateral, superomedial and inferomedial.If all 3 of these genicular nerves are not injected, report 64454 with modifier 52.
64624 Destruction by neurolytic agent, genicular nerve branches, including imaging guidance, when performed
64625 Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)
Note: For radiofrequency ablation, nerves innervating the sacroiliac joint with ultrasound, use 76999
There are three revised codes and two new codes in this section:
Revised Codes:
66711 Ciliary body destruction; cyclophotocoagulation, endoscopic, without concomitant removal of crystalline lens
66982 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage, without endoscopic cyclophotocoagulation
66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), without endoscopic cyclophotocoagulation
New Codes:
66987Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (e.g., iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage, with endoscopic cyclophotocoagulation
66988Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification), with endoscopic cyclophotocoagulation
Several new “T” codes (also referred to as Category III codes) have been created.These codes are designed for emerging technology and allow data collection to determine if a category I CPT code may be relevant in the future.These codes are given a “sunset” date (a date when the code will be either assigned a Category I CPT code, reinstated as a “T” code or archived – archived codes are no longer reportable) of five years from the date of implementation.If a Category III code exists for the services provided, they must be reported with the “T” code and not an unlisted code from the Category I set of codes. Most “T” codes applicable for anesthesia services will be assigned an Anesthesia CPT code in the upcoming 2020 ASA Crosswalk
0543T Transapical mitral valve repair, including transthoracic echocardiography, when performed, with placement of artificial chordae tendineae
0544T Transcatheter mitral valve annuls reconstruction, with implantation of adjustable annulus reconstruction device, percutaneous approach including transseptal puncture
0545T Transcatheter tricuspid valve annulus reconstruction with implantation of adjustable annulus reconstruction device, percutaneous approach
0548T Transperineal periurethral balloon continence device; bilateral placement, including cystoscopy and fluoroscopy
0549T Transperineal periurethral balloon continence device; unilateral placement, including cystoscopy and fluoroscopy
0550T Transperineal periurethral balloon continence device; removal, each balloon
0551T Transperineal periurethral balloon continence device; adjustment of balloon(s) fluid volume
0553T Percutaneous transcatheter placement of iliac arteriovenous anastomosis implant, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention
0565TAutologous cellular implant derived from adipose tissue for the treatment of osteoarthritis of the knees; tissue harvesting and cellular implant creation
0566T Autologous cellular implant derived from adipose tissue for the treatment of osteoarthritis of the knees; injection of cellular implant into knee joint including ultrasound guidance, unilateral
0567TPermanent fallopian tube occlusion with degradable biopolymer implant, transcervical approach, including transvaginal ultrasound
0568T Introduction of mixture of saline and air for sonosalpingography to confirm occlusion of fallopian tubes, transcervical approach, including transvaginal ultrasound and pelvic ultrasound
0569T Transcatheter tricuspid valve repair, percutaneous approach, initial prosthesis
0571T Insertion or replacement of implantable cardioverter-defibrillator system with substernal electrode(s), including all imaging guidance and electrophysiological evaluation (includes defibrillation threshold evaluation, arrythmia termination, and programming or reprogramming of sensing or therapeutic parameters, when performed
0572T Insertion of substernal implantable defibrillator electrode
0573T Removal of substernal implantable defibrillator electrode
0574T Repositioning of previously implanted substernal implantable defibrillator-pacing electrode
0577T Electrophysiological evaluation of implantable cardioverter-defibrillator system withsubsternal electrode (includes defibrillation threshold evaluation, induction of arrythmia, evaluation of sensing for arrythmia termination, and programming or reprogramming of sensing or therapeutic parameters
0580T Removal of substernal implantable defibrillator pulse generator only
0581T Ablation, malignant breast tumor(s), percutaneous, cryotherapy, including imaging guidance when performed, unilateral
0582T Transurethral ablation of malignant prostate tissue by high-energy water vapor thermotherapy, including intraoperative imaging and needle guidance
0584T Islet cell transplant, includes portal vein catheterization and infusion, including all imaging, including guidance, and radiological supervision and interpretation, when performed, percutaneous
0585T Islet cell transplant, includes portal vein catheterization and infusion, including all imaging, including guidance, and radiological supervision and interpretation, when performed, laparoscopic
0586T Islet cell transplant, includes portal vein catheterization and infusion, including all imaging, including guidance, and radiological supervision and interpretation, when performed, open
0587T Percutaneous implantation or replacement of integrated single device neurostimulation system including electrode array and receive or pulse generator, including analysis, programming and image guidance, when performed, posterior tibial nerve
0588T Revision or removal of integrated single device neurostimulation system including electrode array and receiver or pulse generator, including analysis, programming, and imaging guidance when performed, posterior tibial nerve
ASA Crosswalk Changes Crosswalk changes are not released ahead of time and will be provided once they are received – the usual timeline is the second or third week in December, but it has been as late as the last week of the month.
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