2023 CPT Updates: CMS Complexity Adjustment Code Combinations
By Mandeara Frye, RHIA, CPC, CPMA, CASCC, Senior Director, Coding
As of Jan. 1, 2023, CMS implemented 55 new temporary C codes to replace certain service codes and add-on codes. Historically, the use of these add-on codes has not resulted in any additional payment from CMS since they are considered “packaged” codes. The new C codes increase the payable amount to the facility, making their use beneficial for ASCs to understand.
It’s important to note that these codes only apply to the ASC claim. Physicians should continue to report the individual CPTs instead of the C codes. Also, if only the primary service code is performed without the add-on code, the C code should not be used. Only use the primary service code. While these are primarily used by CMS for Medicare claims, check with your commercial carriers for potential coverage as well.
Let's look at two examples representing this new C code application.
1. Interphalangeal joint arthrodesis
Prior to 2023, if a surgeon performed fusion of two finger joints, the procedure would be reported with CPT 26860 and CPT 26861. This procedure combination had a total national payment rate of $1,392.25. This procedure combination is now reported with C7506, which has a total national payment rate of $3,087.84.
26860 Arthrodesis, interphalangeal joint, with or without internal fixation;
+
26861 Arthrodesis, interphalangeal joint, with or without internal fixation;
each additional interphalangeal joint (list separately in addition to
code for primary procedure)
=
C7506 Arthrodesis, interphalangeal joints, with or without internal fixation
2. Percutaneous vertebral augmentation
Similarly, a two-level percutaneous vertebral augmentation (kyphoplasty) was previously reported with CPT 22513 and CPT 22515, with a total national payment rate of $3,087.84. C7507 replaces this combination and has a total national payment rate of $6,331.56.
22513 Percutaneous vertebral augmentation, including cavity creation (fracture
reduction and bone biopsy included when performed) using mechanical device
(eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation,
inclusive of all imaging guidance; thoracic
+
22515 Percutaneous vertebral augmentation, including cavity creation (fracture
reduction and bone biopsy included when performed) using mechanical device
(eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation,
inclusive of all imaging guidance; each additional thoracic or lumbar
vertebral body (list separately in addition to code for primary procedure)
=
C7507 Percutaneous vertebral augmentations, first thoracic and any additional
thoracic or lumbar vertebral bodies, including cavity creations (fracture
reductions and bone biopsies included when performed) using mechanical
device (eg, kyphoplasty), unilateral or bilateral cannulations, inclusive
of all imaging guidance
There are many other code combinations ranging from breast biopsy, to bronchoscopy, to coronary angiography. Depending on the specialties performed at your center, be sure to familiarize yourself with the new codes. The full list of codes with the crosswalk can be found on the CMS website here.
