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Among the changes this year are codes for skin lesion excisions, musculoskeletal therapeutic injections, routine venipuncture and colposcopy.

Fam Pract Manag. 2003;10(1):14

A new year always means new and revised CPT codes. To start 2003 off right and avoid unnecessary denials of your claims, consider the following changes.

Procedural services

One of the most significant changes concerns coding benign and malignant skin lesion excisions. If you code these excisions in 2003 as you did in 2002, you may be undercoding your services. Previously, the correct code depended on the location and size of the lesion itself. In 2003, location is still relevant, but the relevant size refers to the lesion and associated skin margin excised, not just the size of the lesion itself. For example, in 2002, a 1.0–cm benign skin lesion that was excised from the patient’s back with a margin of 0.2–cm on both sides would have been coded using 11401. In 2003, excision of that same lesion with the same margin would be coded using 11402. This change affects codes 11400–11446 and 11600–11646.

There has also been a significant change in the coding of routine venipuncture. Code 36415 has been revised to read “Collection of venous blood by venipuncture.” Previously, this code also included finger, heel and ear sticks for blood specimen collection, but such capillary blood specimen collections should now be coded using the new code 36416.

You should also note that musculoskeletal therapeutic injection codes 20550 through 20553 have been revised to read as follows:

  • 20550, Injection(s); tendon sheath, ligament;

  • 20551, Tendon origin/insertion;

  • 20552, Single or multiple trigger point(s), one or two muscle(s);

  • 20553, Single or multiple trigger point(s), three or more muscle(s).

What are the practical implications of these changes? You should report 20552 and 20553 only once per session, regardless of the number of injections or muscles involved. You should also report 20550 and 20551 only once per tendon sheath, ligament, or tendon origin/insertion, regardless of the number of injections involved. Also note that the words “ganglion cyst” have been removed from 20550, as well as from 20600 and 20605. This is because CPT 2003 includes a new code, 20612, for “Aspiration and/or injection of ganglion cyst(s) any location.”

Colposcopy coding has also changed. In the past, there were only three codes for pelvic endoscopy: 57452, 57454 and 57460. Although these codes were listed under the vagina section of CPT, they were typically used for colposcopy involving the cervix. Accordingly, for 2003, these codes have been revised and moved to the cervix uteri section of CPT, and two new codes, 57420 and 57421, have been added to the vagina section. Two new codes for colposcopy of the vulva, 56820 and 56821, have also been added, along with three new codes for procedures done in conjunction with colposcopy of the cervix uteri. A review of all three sections of CPT may be in order if you do colposcopy in your practice.

Laboratory and other services

The TORCH antibody panel, code 80090, has been deleted. If you previously billed for this service, you will now need to report the codes for the specific tests instead.

Also, to better organize and update the codes in the hematology section, some code descriptors have been revised, new codes have been added and some codes have been deleted. Thus, if you have an office lab or otherwise bill for blood counts in your practice, you should review the hematology section, specifically codes 85004–85049.

Evaluation and management (E/M) services

Most of the E/M codes remain unchanged in 2003. Those that did change are essentially limited to pediatric and neonatal critical care. You should review the CPT critical care services guidelines carefully if you plan to use these codes in the upcoming year.

As always, this represents only some of the annual changes that you will find in CPT. I encourage you to review the 2003 publication for other changes that may be relevant to your practice.

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Copyright © 2003 by the American Academy of Family Physicians.

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