Complex Close with FTSG

Question:

We want to confirm with KZA if a complex closure with extensive undermining is required to close the donor site where an FTSG was taken. Can we separately report the closure?

Answer:

No, this is not separately reportable. The CPT descriptors for the full-thickness skin grafts (FTSG) code set specifically state “including direct closure of the donor site”.

*This response is based on the best information available as of 8/28/25.

Cryoablation of Genicular Nerve

Question:

I'm new to coding pain management procedures. My provider plans to begin performing cryoablation of the genicular nerve under ultrasound guidance. What is the correct way to code this procedure?

Answer:

Great question! The appropriate CPT code for this procedure is 64624 Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed. This code encompasses all methods of nerve destruction, including cryoablation, as well as radiofrequency, thermal, chemical, and electric techniques.

To report CPT 64624 correctly, documentation must reflect destruction of all three key genicular nerve branches:

• Superolateral

• Superomedial

• Inferomedial

If the provider does not treat all three branches, you must append modifier 52 to indicate reduced services. Also, while imaging guidance is included in the code, make sure the medical record documents its use to support the procedure.

*This response is based on the best information available as of 8/28/25.

Infected Total Shoulder Arthroplasty

Question:

Could KZA help me with an orthopedic surgery coding question? Thank you in advance. What code should be used if the provider performed irrigation and debridement with polyethylene exchange in an infected total shoulder?

Answer:

Thank you for your question. Without reviewing the operative note, KZA cannot address a specific case but can help you with general guidelines.

CPT Assistant from September 2021 addresses scenarios for revision arthroplasty. These scenarios are for the hip and knee but are relevant to all other joint arthroplasty procedures, and the same logic is applied to joints outside of the hip and knee.

If there is an exchange of a component in a TJA, CPT Assistant September 2021 guidelines state “when only a single modular component is revised, report the single component with modifier 52.” Therefore, based on your question, (not reviewing the operative note), it is appropriate to code for a single component revision of (23473) appending modifier 52, Reduced Services.

*This response is based on the best information available as of 8/28/25.

Redo Laminectomy Denials (63042 & 63044)

Question:

I am having trouble coding a redo laminectomy. Most get denied, and my surgeon does them all the time. CPT codes 22633 or 22612 are usually the primary codes. I'm still confused about 63042 & 63044. Thank you.

Answer:

Thank you for asking KZA!

This inquiry did not include an operative note or denial information. Without this, KZA will provide some general coding guidance.

If the diagnosis is not disc-related, codes 63042 & 63044 would not be appropriate to report with codes 22633 or 22612. Additionally, CPT code 22633 includes discectomy; it would not be appropriate to report 63042. These could be the source of the denials received.

Key Takeaways:

• Laminectomy coding is diagnosis-driven. Generally, reviewing the pre-/postoperative diagnoses and indications will provide this detail; if not, querying the surgeon is advised for clarification.

• There are only reexploration codes for disc (6304x). If the diagnosis is not disc, Modifier 22 could be potentially considered if the documentation reflects and supports additional procedural services.

• Lumbar interbody fusion codes (22630-22634) – include discectomy (63030/63035 & 63042/63044).

• Lumbar interbody fusion codes (22630-22634) have add-on codes (63052/63053) to reflect additional decompression beyond laminectomy/discectomy sufficient to prepare the interspace.

*This response is based on the best information available as of 8/28/25.

E/M for PAD with Ultrasound Order

Question:

How would we code for an established office visit for a patient with PAD and an order for an ultrasound?

Answer:

In terms of EM elements, PAD would support a chronic condition for a moderate problem, combined with an ultrasound (minimal risk) which would support a 99212 established visit.

*This response is based on the best information available as of 8/28/25.

Bone Anchored Hearing Implants

Question:

What CPT code would I report for implanting a bone anchored osseointegrated implant with a magnetic transcutaneous attachment outside of the mastoid?

Answer:

In 2023 three new CPT were created to report Transcutaneous osseointegrated implants outside of the mastoid. For the implantation the code to report is 69729, for the replacement of the existing device report 69730 and for the removal of the implant report 69728.

*This response is based on the best information available as of 8/28/25.