How To Use CPT Code 20985

CPT 20985 refers to a computer-assisted surgical navigational procedure for musculoskeletal procedures without the use of preoperative imaging. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 20985.

1. What is CPT 20985?

CPT 20985 is a code used to describe a computer-assisted surgical navigational procedure for musculoskeletal procedures, specifically those that do not require preoperative imaging studies. This code is used to report the intraoperative application of a computer-assisted navigation system (CANS) during a musculoskeletal procedure, which helps the provider make more accurate measurements and ensure better fitting surgical components, leading to faster healing and less postoperative pain for patients.

2. 20985 CPT code description

The official description of CPT code 20985 is: “Computer-assisted surgical navigational procedure for musculoskeletal procedures, image-less (List separately in addition to code for primary procedure)”.

3. Procedure

The 20985 procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider brings the computer-assisted navigation system (CANS) into the operative field.
3. Navigation software is activated, and patient-specific information is entered, such as patient identifiers, name of provider, and site of surgery.
4. Pins that hold trackers or markers are positioned on the surgical site within the camera’s field of view to be used as a navigational aid during the surgical procedure.
5. Trackers are registered with the computer navigation system, allowing the system to recognize and remember the trackers and their location, rendering a more accurate digital image of the surgical site.
6. The provider proceeds with the surgical procedure, viewing the operative site through the screen of the computer navigation unit.

4. Qualifying circumstances

Patients eligible to receive CPT code 20985 services are those undergoing musculoskeletal procedures where the use of a computer-assisted navigation system is deemed medically necessary. This may include joint replacement surgeries, spinal surgeries, or other complex musculoskeletal procedures where the provider believes that the use of a CANS will improve the accuracy and outcome of the surgery.

5. When to use CPT code 20985

It is appropriate to bill the 20985 CPT code when a provider performs a musculoskeletal procedure using a computer-assisted navigation system without preoperative imaging. This code is an add-on code and must be reported with an allowable primary musculoskeletal procedure code. Medicare will reimburse for 20985 when the computer-assisted navigation is medically necessary and performed with another procedure.

6. Documentation requirements

To support a claim for CPT 20985, the following information needs to be documented:

• Patient identifiers and demographics
• Name of the provider performing the procedure
• Site of surgery
• Details of the primary musculoskeletal procedure performed
• Use of the computer-assisted navigation system, including the registration of trackers and the use of the system during the procedure
• Medical necessity for the use of the computer-assisted navigation system

7. Billing guidelines

When billing for CPT code 20985, it is important to remember that it is an add-on code and must be reported with an allowable primary musculoskeletal procedure code. Do not report 20985 in conjunction with codes 61781-61783. For computer-assisted navigational procedures with image guidance based on pre-operative and intraoperatively obtained images, use codes 0054T and 0055T instead.

8. Historical information

CPT 20985 was added to the Current Procedural Terminology system on January 1, 2008. The code was changed on January 1, 2009, with the previous descriptor being “Computer-assisted surgical navigational procedure for musculoskeletal procedures; image-less (List separately in addition to code for primary procedure)”.

9. Similar codes to CPT 20985

Five similar codes to CPT 20985 and how they differentiate are:

1. CPT 0054T: This code is used for computer-assisted navigational procedures with image guidance based on pre-operative images.
2. CPT 0055T: This code is used for computer-assisted navigational procedures with image guidance based on intraoperatively obtained images.
3. CPT 61781: This code is for a stereotactic computer-assisted volumetric (navigational) procedure for the brain, which is not to be reported with CPT 20985.
4. CPT 61782: This code is for a stereotactic computer-assisted volumetric (navigational) procedure for the spine, which is not to be reported with CPT 20985.
5. CPT 61783: This code is for a stereotactic computer-assisted volumetric (navigational) procedure for the skull base, which is not to be reported with CPT 20985.

10. Examples

Here are 10 detailed examples of CPT code 20985 procedures:

1. Computer-assisted navigational procedure for a total knee replacement without preoperative imaging
2. Image-less computer-assisted navigational procedure for a total hip replacement
3. Computer-assisted navigational procedure for a spinal fusion surgery without preoperative imaging
4. Image-less computer-assisted navigational procedure for a shoulder arthroplasty
5. Computer-assisted navigational procedure for an ankle joint replacement without preoperative imaging
6. Image-less computer-assisted navigational procedure for a complex wrist surgery
7. Computer-assisted navigational procedure for a revision of a total knee replacement without preoperative imaging
8. Image-less computer-assisted navigational procedure for a revision of a total hip replacement
9. Computer-assisted navigational procedure for a complex elbow surgery without preoperative imaging
10. Image-less computer-assisted navigational procedure for a complex foot surgery