Neurectomy and Amputations

Question:

Hello, Can you provide any guidance regarding the neurectomy and the code descriptions of 26951 and 26952. Are these required to be documented in traumatic cases where the nerves were already transected or where there is a revision being done encompassing all the other elements of the amputation, except vessel, ligation or neurectomy?

Answer:

Thank you for contacting KZA with your question regarding neurectomy and amputation codes 26951 and 26952. 26951 Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with direct closure and 26952 with local advancement flaps (V-Y hood) describe completed amputation procedures.  The reference to neurectomies in code 26951 reflects a component of the work typically associated with performing the amputation.  

In the setting of a traumatic amputation a neurectomy may not be necessary if the digital nerve has already been completely transected by the injury. In that situation, it would not be appropriate to document that a neurectomy had been performed if it was not actually required or carried out. The surgeon's documentation should indicate what was performed during the amputation procedure, debridement, revision of soft tissue, contouring bone, wound closure.  

*This response is based on the best information available as of 10/08/26.

Destruction of Keloid

Question:

Is there a code for the destruction of a keloid scar with a laser?

Answer:

Destruction of a keloid scar with a laser would be appropriately reported with code 17110.

This code describes the destruction of benign lesions other than skin tags or cutaneous vascular proliferative lesions up to 14 lesions.

Thank you for reaching out to KZA!

*This response is based on the best information available as of 10/08/26.

Cast Reapplication Conundrum

Question:

The patient initially presented with a wrist sprain and was treated with a short arm splint. Two days later, the patient returned due to the splint becoming wet or loose, and the physician removed and reapplied a new short arm splint. In this scenario, can the splint procedure be separately reported, or is it included in the E&M service?

Answer:

The reapplication can be billed separately using the appropriate application code.  It is not automatically included in the EM code. 

The CPT guidelines specifically states that while the initial application of a cast or splint is bundled into the fracture treatment, reapplications are reported separately using the 29000-29799 series.  

To support the EM, the note must show that the doctor's medical decision making went beyond just the mechanics of the splint replacement.  Most cast and splint application codes have a 0 day global period, because there is no surgical package associated with the wrist sprain, the reapplication on a subsequent day is billable.

*This response is based on the best information available as of 10/01/26.

Bilateral SPRINT PNS Leads

Question:

Can you clarify coding for bilateral SPRINT PNS leads on the same nerve for the temporary 60 day treatment?

Answer:

Peripheral Nerve Stimulation or PNS is coded to 64555 Percutaneous implantation of neurostimulator electrode array; peripheral nerve (excludes sacral nerve). CPT Assistant has published several articles on the use of CPT 64555 for both temporary and permanent implantation. 

CPT 64555 has a bilateral indicator of "0", therefore, modifier 50 is not appropriate to append as the code descriptor does not indicate unilateral or bilateral.  

Payor policy would determine if CPT 64555 with laterality modifiers LT/RT would be billable.

*This response is based on the best information available as of 10/01/26.

Pedicle Screws & Cement Augmentation

Question:

Pedicle screw with cement augmentation—Is there a separate code for this, or is it included in the instrumentation codes (e.g., 22840, 22842)?

Answer:

Great question, and one that comes up often. Cement augmentation of pedicle screws is considered integral to the instrumentation procedure. There is no separate code for the cement augmentation; it is included in the instrumentation code reported.

Thank you for reaching out to KZA!

*This response is based on the best information available as of 09/17/26.

Newborn Duodenoduodenostomy without Resection

Question:

The provider repairs a duodenal atresia in a newborn with a Diamond duodenoduodenostomy. Which CPT is more appropriate to bill for 44126-52 (for no resection done) or 44130-63 (Pt under 4 kg)?

Answer:

CPT guidelines advise us to “select the CPT code of the procedure or service that accurately identifies the procedure or service performed.” Because there is a CPT code that accurately captures the work performed without the use of the reduced services modifier, CPT 44130 would be the appropriate code to report the duodenoduodenostomy. Modifier 63 would be appended if the infant is less than 4 kg.

*This response is based on the best information available as of 09/17/26.