Resolved 20700 or 20704

[MarisaM_62351]

Hello!!
Can someone please tell me what CPT code 20704 represents? Is it for joint spacers only? Or can this code also be used for antibiotic beads placed in the hip joint? or would 20700 be the most appropriate for the beads placement in the hip joint?
Thank you!!

 

[Lori]

Code 20704 is a Manual preparation and insertion of drug-delivery device(s), intra-articular (List separately in addition to code for primary procedure)

To report the insertion and removal of antibiotic beads, use CPT codes 11981 (Insertion, non-biodegradable drug delivery implant), 11982 (Removal, non-biodegradable drug delivery implant), and 11983 (Removal with reinsertion, non-biodegradable drug delivery implant).

 

[MarisaM_62351]

Code 20704 is a Manual preparation and insertion of drug-delivery device(s), intra-articular (List separately in addition to code for primary procedure)

To report the insertion and removal of antibiotic beads, use CPT codes 11981 (Insertion, non-biodegradable drug delivery implant), 11982 (Removal, non-biodegradable drug delivery implant), and 11983 (Removal with reinsertion, non-biodegradable drug delivery implant).

Even if the doc prepared the antibiotic cement, rolled into 22 beads, strung them together with a suture and placed in hip?

 

[Lori]

6 Add-on Codes for Drug Delivery Device Implantations
Implantable drug delivery systems allow targeted drug delivery at a consistent, predetermined rate. They enable optimal dosing during treatment, minimize potential side effects, and improve treatment efficacy. Implantable drug delivery devices are widely used in diseases that need long term therapy or posepatient compliance problems, such as cardiovascular disease, tuberculosis, diabetes, cancer, and chronic pain management.

In orthopedic surgery, drug-releasing implants allow local drug delivery to the bone to treat infection. These implants come in various sizes, from a tiny “antibiotic bead” to an antibiotic loaded cement knee prosthesis spacer. Drug delivery implants can be biodegradable or non-biodegradable. Non-biodegradable antibiotic implants implanted during surgery to relieve post-op pain will be removed in the office as part of the post-op care services.

There are 6 new add-on codes for the manual preparation and insertion as well as removal of implants for the delivery of drugs to deep musculoskeletal spaces:

• 20700 Manual preparation and insertion of drug-delivery device(s); deep(eg, subfascial) (List separately in addition to primary procedure) (usually polymethylmethacrylate beads on a wire with Tobramycin or Vancomycin)
• 20702… Manual preparation and insertion of drug-delivery device(s), intramedullary (List separately in addition to primary procedure) (mostly trauma surgeons, beads like above)
• 20704… Manual preparation and insertion of drug-delivery device(s), intra-articular (List separately in addition to primary procedure) (Spacer out of box is inherent (i.e. in 27488) and not coded separately)
• 20701 Removal of drug-delivery device(s); deep(e.g., subfascial) (List separately in addition to primary procedure)
• 20703 Removal of drug-delivery device(s), intramedullary (List separately in addition to primary procedure)
• 20705 Removal of drug-delivery device(s), intra-articular (List separately in addition to primary procedure)

Coding drug delivery implantations – points to note

• These services are add-on codes and always reported in conjunction with other procedures. The primary codes with which the add-on codes can be reported are indicated in the parenthetical notes.
• The new 2020 add-on codes by area inserted can be reported once per anatomic location.
• The new codes for drug delivery involve manual mixing and preparation of antibiotics or other therapeutic agents with a carrier substance by the physician or QHP during the surgical procedure. The mixture is then placed on the delivery device such as nails, beads, or spacersby the provider.
• Drug delivery implants that come premixed or boxed already have the drug infused into them. This implies that no manual mixing by the physician is required. The CPT codes to report premixed drug delivery implants are:
  • 11981 Insertion, non-biodegradable drug delivery implant
  • 11982 Removal, non-biodegradable drug delivery implant
  • 11983 Removal with reinsertion, non-biodegradable drug delivery implant
• Medical coders need to know how to identify the type of drug delivery system from the clinical documentation and correctly assign drug delivery implant codes. For instance, a Health Information Associates (HIA) article cautions that coders should not confuse articulating spacers with drug delivery systems. Articulating spacers are implants done for revisions and should be reported using CPT code 27487 (Revision of total knee arthroplasty, with or without allograft;

CPT Code Changes impacting Orthopedics in 2020

In FY 2020, there are several new musculoskeletal CPT codes and guidelines impacting chiropractic and orthopedic medical billing.

www.outsourcestrategies.com

 

[MarisaM_62351]

Thank you!!!