How To Use CPT Code 0055T

CPT 0055T describes a computer-assisted musculoskeletal surgical navigational orthopedic procedure that utilizes image-guidance based on CT/MRI images. This article will cover the description, official definition, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 0055T?

CPT 0055T can be used to describe a computer-assisted musculoskeletal surgical navigational orthopedic procedure that incorporates image-guidance based on CT/MRI images. This code is used when a provider utilizes surgical navigation technology to help guide and validate the type and position of an orthopedic implant during a reconstruction or replacement procedure for the knee or hip.

2. Official Description

The official description of CPT code 0055T is: ‘Computer-assisted musculoskeletal surgical navigational orthopedic procedure, with image-guidance based on CT/MRI images (List separately in addition to code for primary procedure).’ It is important to note that when both CT and MRI are performed, this code should only be reported once.

3. Procedure

1. The provider begins by using a computer equipped with surgical navigation technology.
2. CT or MRI images are obtained during preoperative data acquisition to plan the surgery and simulate the procedure.
3. During the procedure, the provider updates fluoroscopic images and data in real time to display the position of surgical implants on a computer screen in relation to the patient’s anatomy.
4. Magnetic, acoustic, or optical signal markers are placed on instruments, bone structures, and implants.
5. A tracking sensor is placed overlooking the surgical field to receive marker signals and display their relative position on the monitor.
6. The provider creates a bone surface shape model from preoperative images and superimposes surface data points collected during surgery.
7. The provider uses continuous computer-generated video imaging to guide the instrumentation and ensure precise placement and positioning of the implants.

4. Qualifying circumstances

CPT 0055T is applicable when a provider utilizes computer-assisted surgical navigation technology based on CT/MRI images to guide and validate the type and position of an orthopedic implant during a knee or hip reconstruction or replacement procedure. This procedure can be performed using either an open system, which is compatible with any manufacturer’s instruments and joint prostheses, or a closed system, which is specific to a manufacturer’s surgical instruments and implants.

5. When to use CPT code 0055T

CPT code 0055T should be used when a provider performs a computer-assisted musculoskeletal surgical navigational orthopedic procedure with image-guidance based on CT/MRI images. It is important to note that this code should be reported in conjunction with a primary orthopedic procedure code. Additionally, it is crucial to report this code only once, even if both CT and MRI image guidance are utilized.

6. Documentation requirements

To support a claim for CPT code 0055T, the provider must document the following information:

• Use of computer-assisted surgical navigation technology
• CT/MRI images obtained during preoperative data acquisition
• Length or volume measurements obtained from the images
• Fluoroscopic images and data updated in real time during the procedure
• Position of surgical implants displayed in relation to the patient’s anatomy
• Marker placement and tracking sensor utilization
• Bone surface shape model created from preoperative images
• Surface data points collected during surgery
• Continuous computer-generated video imaging used for precise guidance of instrumentation

7. Billing guidelines

When billing for CPT code 0055T, ensure that the procedure meets the criteria for a computer-assisted musculoskeletal surgical navigational orthopedic procedure with image-guidance based on CT/MRI images. This code should be reported in addition to the primary procedure code. It is important to note that this is an add-on code and should not be reported alone. For fluoroscopic image guidance, a separate code should be used. It is advisable to consult with the payer regarding coverage and reimbursement for this procedure.

8. Historical information

CPT code 0055T was added to the Current Procedural Terminology system on January 1, 2004. There have been no updates or changes to the code since its addition.

9. Examples

1. A provider utilizes computer-assisted surgical navigation technology to guide the placement of an orthopedic implant during a knee reconstruction procedure.
2. During a hip replacement surgery, a provider relies on image-guidance based on CT/MRI images to ensure accurate positioning of the orthopedic implant.
3. A surgeon performs a knee replacement procedure using computer-assisted musculoskeletal surgical navigational orthopedic techniques with image-guidance based on CT/MRI images.
4. For a patient undergoing hip reconstruction, a provider utilizes surgical navigation technology to validate the type and position of the orthopedic implant.
5. A provider uses CT/MRI image-guidance during a knee replacement surgery to assist with precise placement of the orthopedic implant.
6. During a hip reconstruction procedure, a surgeon utilizes computer-assisted surgical navigation technology to guide the positioning of the orthopedic implant based on CT/MRI images.
7. A provider performs a knee replacement surgery using image-guidance based on CT/MRI images and computer-assisted musculoskeletal surgical navigational techniques.
8. For a patient undergoing hip replacement, a surgeon relies on computer-assisted surgical navigation technology and image-guidance to ensure accurate placement of the orthopedic implant.
9. A provider utilizes CT/MRI image-guidance and computer-assisted surgical navigation techniques during a knee reconstruction procedure.
10. During a hip replacement surgery, a surgeon uses computer-assisted musculoskeletal surgical navigational orthopedic techniques and image-guidance based on CT/MRI images to guide the placement of the orthopedic implant.