CPT 42160 for Laser Ablation of a Soft Palate Papilloma

Question:

Can CPT code 42160 be used for a laser ablation of the velum surface of the soft palate papilloma (ie. is the laser considered thermal)?

Answer:

CPT 42160 is reported based on destruction of the lesion. If the documentation supports destruction of a soft palate papilloma, laser ablation qualifies as a thermal technique and meets the criteria for the code.

*This response is based on the best information available as of 03/05/26.

Clarification on Consultation Codes

Question:

After reviewing the First Patient Encounter question and answer. Would this still be considered a consult since the problem is already established with the provider? "The admitting physician has asked me to see the patient again for that same condition" New vs established does not pertain to IP/Consult codes. However can they bill a consult on an established diagnosis?

Answer:

Consultation codes may be used for patients previously seen for the same condition, provided the provider did not assume ongoing care during prior encounters and is not assuming management in the current hospitalization. The key distinction lies in seeking an opinion or advice versus assuming care and management of the condition. To report a consultation, a formal physician request must be documented, a clinical evaluation and recommendations must be provided, and findings must be communicated back to the requesting provider. Previous encounters do not disqualify the use of consultation codes if these requirements are met and the current request genuinely seeks consultation rather than care management. However, if the provider is already treating and managing the condition, consultation codes are not appropriate when the requesting provider asks them to see a patient already under their active care.

*This response is based on the best information available as of 03/05/26.

Osteotomy & Laminectomy Same Level

Question:

I have a question about a complicated surgery and was hoping to get some feedback, as I've been receiving mixed responses and want to ensure these procedures are being reported accurately. Am I able to report any laminectomy that overlaps at the same levels as spinal osteotomies?

Answer:

Great question! Spinal osteotomy is performed to correct spinal deformity and includes laminectomy and decompression at the same level. Because these components are considered inherent to the osteotomy procedure, it is not appropriate to report the laminectomy separately at the same level.

To ensure accurate coding, the operative report should clearly document:

• The type of spinal deformity

• The degree of correction being sought by osteotomy

• Details of how the osteotomy was performed

• The resulting changes from osteotomy

 If the documentation supports spinal osteotomy, it encompasses the laminectomy at that level.

 Thank you for reaching out to KZA with your inquiry.

*This response is based on the best information available as of 03/05/26.

Epidermoid Cyst

Question:

My physician removed an epidermoid cyst and I am not certain how to code this. What CPT code is used for the removal of a 1.2 cm epidermoid cyst on the scalp that is removed through a small linear incision, is dissected and removed in total. I think I should use the I&D code 10060 but I am not sure. Can you help?

Answer:

Thank you for your question. Because the cyst was removed through a small linear incision, dissected free and removed in total (en bloc) from the scalp, this meets the definition of a benign lesion excision not an incision and drainage (I&D). The correct CPT code based on the 1.2cm size and anatomic location is 11422 (Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm).

*This response is based on the best information available as of 03/05/26.

Two Stage ACL Treatment

Question:

Our docs have been seeing more patients that have had a re-tear of ACL and are wanting to do bone grafting of tunnels in addition to medial and lateral meniscectomies and removal of hardware and evaluate the ACL to see if it repairable. We are wondering if the bone grafting is separately billable and what code we should use for this?

Answer:

Thank you for your inquiry and recognizing we are not able to provide definitive coding advice without an operative note. This is a good question.

There is no specific CPT code for the first of two stage revision of an ACL. Current guidance for the removal of plugs, debridement of tunnels and filling the tunnels with a bone substitute is coded to 29999. 

*This response is based on the best information available as of 03/05/26.

ICD-10 - Asymmetry Not Following Reconstruction

Question:

Looking for some ICD-10 advice from KZA. In instances in which a patient presents to our practice for breast asymmetry following lumpectomy, and no reconstruction has been performed, is N65.1 appropriate to report? If not, what is the proper ICD-10 code?

Answer:

Great question! Since no reconstruction has been performed, the ICD-10 code N65.1 is not appropriate, as that code specifically applies to disproportion of a reconstructed breast.

For cases of breast asymmetry following lumpectomy without reconstruction, the most accurate code is N64.89, which includes other specified breast disorders and is appropriate for asymmetry unrelated to reconstruction.

Using the correct diagnosis code supports accurate documentation, billing compliance, and quality reporting. Misapplying codes such as N65.1 may result in claim denials or inaccurate clinical data.

Thank you for reaching out to KZA with your inquiry.

*This response is based on the best information available as of 03/05/26.