Instrumentation for CPT 69210

Question:

For CPT 69210, is suction, by itself, considered instrumentation for this procedure code?

Answer:

According to the AAO-HNS, using CPT code 69210 is reported based on what instruments are used to remove the impacted ear wax.  Instrumentation is defined as the use of an otoscope and instruments such as wax curettes, wire, loops or suction specific ear instruments (e.g., cup loops, right angle hook) or a similar tool designed for controlled wax extraction. Documentation should indicate the equipment used to provide the service.  

*This response is based on the best information available as of 07/16/26.

Pilonidal Disease Excision

Question:

I frequently perform adjacent tissue transfers (CPT 14000, 14001, 14020). When I excise pilonidal disease (CPT 11770, 11771, 11772) and then perform an adjacent tissue transfer, can I report both the excision and the tissue transfer codes, or is only the tissue transfer separately billable?

Additionally, in cases where I excise a malignant lesion (CPT 11604, 11606) and close the defect with an adjacent tissue transfer, my understanding is that only the adjacent tissue transfer code (e.g., 14000) is reportable, and the excision is considered included. Is this correct?

Answer:

This is a great question. Even though pilonidal excision is a “disease excision” rather than a lesion excision, CPT still treats the excision as included in the ATT. If you excise pilonidal disease and close with an adjacent tissue transfer (e.g., Limberg flap, Karydakis flap, Z-plasty), you bill only the ATT code (14000–14001–14020 etc.). Keep in mind when you perform an adjacent tissue transfer to close a defect, you do NOT separately bill the excision of a lesion (benign or malignant).

The ATT includes:

• Creating the defect (whether by trauma or excision)

• Preparing the wound bed

• Closing the defect with the flap

The excision is considered included in the ATT code.

This applies to:

• Benign lesion excision (11400 series)

• Malignant lesion excision (11600 series)

• Benign cyst excision (e.g., pilonidal disease 11770–11772)

• Scar revision excision

• Any excision that results in the defect you are closing with ATT

*This response is based on the best information available as of 07/16/26.

Laparoscopic Male Sling

Question:

What is the CPT code for robotic-assisted laparoscopic male sling using an in situ vascularized peritoneal flap? Is CPT 51992 applicable or is this specific for female genital system?

Answer:

CPT 51992 is not a gender-specific code; therefore, it can be reported for patients of any gender.

This is further supported by the CPT Knowledge Base response published on 4/8/2013 that recommends reporting CPT 51992 with prostatectomy CPT 55866.

*This response is based on the best information available as of 07/16/26.

Hill Sachs Lesion

Question:

I'm specifically looking for guidance on how to code for a repair of a humeral head Hill Sachs lesion when done with arthroscopic Bankart repair or SLAP repair.

Answer:

Repairing the Hill Sachs lesion, bony defect in the humeral head, is typically performed along with a Bankart repair, with the addition of filling in the defect with the rotator cuff tendon. There are several different references on how to correctly code for this. CPT Assistant July 2015 states to code an Arthroscopic Bankart Repair with a repair of the Hill Sachs lesion by appending modifier 22 to the Bankart repair, 29806-22. The same guidance would apply for an Arthroscopic SLAP lesion repair with a Hill Sachs lesion, CPT 29807-22.

*This response is based on the best information available as of 07/09/26.

Diagnostic Ultrasound Followed by Ultrasound Guided Injection

Question:

We have a Pain Interventionalist performing diagnostic MSK ultrasounds, followed by an ultrasound guided injection. We bill both codes but the claims keep bundling. Is there a way to avoid this?

Answer:

Thank you so much for reaching out with your question. Based on your question, KZA is happy to share the general guidelines for Ultrasound billing with you. An ultrasound-guided injection, for example CPT 20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting, involves a focused ultrasound assessment. This includes capturing, labeling, and interpreting images from different angles around the affected area. The goal is to find the best approach for the injection, while noting normal anatomy and any signs of issues. Imaging helps guide the needle safely into the joint or bursa, avoiding bones, blood vessels, and other sensitive structures. Afterward, the findings are carefully documented in the patient’s chart to keep everyone informed. If a diagnostic ultrasound is performed at the same location, it’s included as part of the ultrasound-guided procedure.  

If a diagnostic ultrasound is performed at the separate anatomic location, a modifier 59 or X{ESPU} modifier may be appropriate. Please know that this will be under high scrutiny with the payors. 

KZA has free KZA KAST podcasts on both modifier 59 and the subset X {ESPU} for additional information on the appropriate application of these modifiers. 

Modifier 59 - Part 1

https://monday.transistor.fm/episodes/modifier-59-part-1

Subset Modifier XE

https://monday.transistor.fm/episodes/subset-modifier-xe

*This response is based on the best information available as of 07/09/26.

Breast Reduction with Lipo

Question:

I am looking for KZA’s recommendation. If both a breast reduction (19318), and a suction-assisted lipectomy (15877) is also performed can both procedures be reported?

Answer:

Suction-assisted lipectomy performed to enhance the outcome of a breast reduction is considered part of the primary procedure and is not separately reportable. Additionally, according to NCCI edits, code 15877 is bundled with 19318. Therefore, if the documentation supports both open excision of breast tissue for reduction and suction-assisted lipectomy, it would be appropriate to report only 19318.

Thank you for reaching out to KZA with your inquiry.

*This response is based on the best information available as of 07/09/26.