Dr Voss from AAOS did the presentation at the AMA 2020 symposium regarding the new drug delivery codes and stated we are not to use the 1198x series.
The new drug delivery codes are for static, non-articulating spacers. If they are placing articulating spacer you are to use the revision codes when it comes to situations like infected total joints.Anytime that they are using an articulating spacer the revision codes will be used everytime.
Anytime that they are using a static spacers you will use the removal prosthesis code for the initial and then final you would report the new removal of spacer code 20705 for totals along with a placement code.
Example THA
Infected left THA were they remove the prosthesis and place a static spacer. The billing would be 27091.
Infection all gone and patient present for inserting a new total joint. They remove the static spacer 20705 and code 27132. This is what we have been doing
Infected left THA were they remove the prosthesis and place an articulating spacer. The billing would be 27134.
Infection all gone and patient present for inserting a new total joint. They remove the articulating spacer and code 27134.
Example TKA
Infected left TKA were they remove the prosthesis and place a static spacer. The billing would be 27488.
Infection all gone and patient present for inserting a new total joint. They remove the static spacer 20705 and code 27447. This again is how we have been doing it.
Infected left TKA were they remove the prosthesis and place an articulating spacer. The billing would be 27487.
Infection all gone and patient present for inserting a new total joint. They remove the articulating spacer and code 27487.
During the question and answering session I asked the AMA and Dr. Voss how people are going to know of this change if they didn't attend the symposium. They stated that an article will be published and they are telling their members.
The other problem is in the CPT manual the list of primary codes that are allowed with the drug delivery codes, there are many missing and we were told to send any missing ones to AAOS and AMA.
These drug delivery spacer/beads/seeds codes can be used for other than infected joints such as for fractures, infections of other issues.
You need to have your surgeons state in the op note what kind of spacer, static vs. Articulating