2019 CPT changes for general surgery

The Current Procedural Terminology, (CPT) implemented code set for 2019 includes a few updates of interest to general surgery and its related specialties. Particularly, new codes have been established that bundle coding for imaging guidance with fine needle aspiration (FNA) and expand the number of skin biopsy codes. These changes are effective as of January 1, 2019.

Integumentary System
A new code subsection has been added for Fine Needle Aspiration Biopsy (FNA). Multiple new codes have been added to the new subsection to describe FNA codes with and without guidance (e.g., ultrasound, fluoroscopic, CT and MR guidance) and to describe the initial lesion and additional lesions.

Fine Needle Aspiration Biopsy (FNA)
New Codes: 10004 - 10012
Code 10021 - Fine needle aspiration; without imaging guidance has been revised.
The new code description reads as:
Fine needle aspiration; without imaging guidance, first lesion

Skin, Subcutaneous, and Accessory Structures
New Codes: 11102 – 11107

Several new codes have been introduced to identify reporting for different types of biopsy (e.g., tangential, punch, incisional)
Codes 11100 - Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; single lesion and 11101 - Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; each separate/additional lesion (List separately in addition to code for primary procedure) have been deleted.

Lymph Nodes and Lymphatic Channels
New Codes:

38531 - Biopsy or excision of lymph node(s) open, inguinofemoral node(s) has been introduced to add excision of inguinofemoral nodes to the lymph nodes and lymphatic channels code family. Code 38531 has been added to the parenthetical for add-on code 38900 - Intraoperative identification (e.g., mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (List separately in addition to code for primary procedure). Both codes may be reported together when performed.

A parenthetical has been added to the codes for partial and complete radical vulvectomy (56630-56632 and 56633-56637) instructing the user to report code 38531when an inguinfemoral lymph node biopsy is performed without a complete inguinfemoral lymphadenectomy.