American Medical Association adds new, amended, and removed codes to the CPT code set, along with logic and rationale for the changes every year. The Musculoskeletal System component of the CPT code set for 2022 has undergone considerable modifications, with numerous updates in both guidelines and definitions.
System Musculoskeletal: Bones, muscles, tendons, ligaments, and soft tissues comprise your musculoskeletal system. They work together to support your body’s weight and help you move. Injuries, sickness, and aging can cause pain, stiffness, and other movement and function issues. You can keep your musculoskeletal system healthy by taking care of your general health.
How Does The Musculoskeletal System Function?
The neurological system controls your voluntary muscular movements. Voluntary muscles are those that you deliberately control. Some actions, such as jumping, require using huge athletic groups. Others make minor movements, such as pressing a button. Movement occurs when:
- Your brain and nerves signal your skeletal (voluntary) muscles to engage.
- Your muscle fibers contract (tight up) in response to the communication.
- When the muscle contracts or constricts, it pushes on the tendon. Tendons are the fibrous bands that connect muscles to bones.
- The tendon pushes on the bone and causes it to move.
- Your neurological system sends another instruction to relax the muscle. It causes muscles to relax or deactivate.
- The relaxed muscle relieves tension, allowing the bone to rest.
Fracture/Dislocation Treatment Definitions Updates
The following fracture/dislocation therapy definitions have also been updated to clarify each treatment offered:
Manipulation: Reduction through manually applied forces or traction to achieve adequate fracture or dislocation alignment. If proper alignment is not maintained and a fracture or dislocation requires repeated re-reduction by the same physician or trained health professional, add modifier 76 to the fracture/dislocation treatment code.
Traction: A distraction or traction force applied to the spine or a limb. It is further divided into two following types.
Skeletal Traction: This traction refers to using a wire, pin, screw, or clamp fastened to the bone.
Skin traction: The force applied to a limb solely through strapping or a device placed directly to the skin is known as skin traction.
Closed Treatment: In closed treatment, no surgical incisions are made at the treatment location (i.e., not exposed to the external environment nor directly visualized). Closed fracture/dislocation treatment can be done without manipulation (e.g., by applying a cast, splint, or strapping) and through manipulation through skeletal traction and skin traction. Closed treatment does not include casting, splinting, or strapping used to temporarily stabilize the fracture for patient comfort.
Open Treatment: The site is surgically opened to expose the fracture/dislocation to the external environment for treatment, or the fracture/dislocation is treated via the traumatic wound or an extension thereof, or an intramedullary nail or by placing another internal fixation device via a surgical exposure remote from the fracture site, with or without direct visualization of the fracture site.
External fixation: It is the use of pins and wires that enter the bone(s) and connector devices (such as clamps, bars, and rings) to repair fractures and dislocations. External fixation can treat fractures and dislocations either temporarily or permanently. External fixation is of the following two types.
Uniplanar external fixation: In this fixation, all pins are placed almost in the same plane, but triangular fixation across a joint is also possible.
Multiplanar external fixation: In this kind of external fixation, transosseous wires and threaded pins are put in various planes and held in place by interconnected stabilizing and tensioning rings and half rings in
External fixation can be prescribed to treat all sorts of fractures and dislocations (i.e., closed, percutaneous, open). Codes for external fixation are given separately only when external fixation is not mentioned as intrinsic to the method in the code descriptor.
Percutaneous skeletal fixation: It is a non-invasive treatment option. The fracture fragments are not seen in this treatment, but fixation (e.g., pins, screws) is inserted across the fracture site, generally with imaging guidance.
CPT Updates For 2022
CPT code 0707T: To record the injection of bone-substitute material into a subchondral bone defect, incorporating imaging guidance and arthroscopy aid for joint visualization, a new CPT code 0707T has been established.
CPT code 0707T now has a parenthetical remark directing coders that it should not be reported with CPT codes (29805, 29860, 29870, or 77002).
Following code 20615 in the Musculoskeletal System section, a parenthetical remark has been added directing coders to report code 0707T for injection of bone-substitute material for bone marrow lesions under the establishment of code 0707T.
New Guidelines for the Closed Treatment of Nasal Fractures
The following methods of closed therapy for nasal bone fractures are available:
- Without manipulation
- Stabilization with manipulation
- With manipulation and without stabilization
Codes Related Closed Treatment Of Nasal Fractures
CPT code 21310: This code is related to the closed treatment of nasal bone fracture without manipulation.
CPT code 21315: This code deals with the closed treatment of nasal bone fracture; without stabilization.
CPT code 21320: This code is specially designed to deal with the closed treatment of nasal bone fracture; with stabilization.
The CPT mentioned above codes related to the closed treatment of nasal fractures did not specify how to report manipulation when performed in conjunction with closed therapy before 2022. To remedy this, code 21310, Closed treatment of nasal bone fracture without manipulation, was eliminated, and codes 21315 and 21320 were updated.
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