Closure Following Mohs Surgery

Question:

If a patient is referred to a plastic surgeon after a Mohs surgeon performs a Mohs procedure, to perform a complex repair, do I need to add a modifier to the plastic surgeon's repair code?

Answer:

Thank you for your question. You do not need a modifier on the plastic surgeon’s repair code when the Mohs surgeon and the repairing surgeon are different specialties.

When two different physicians perform services on the same day, Medicare and most commercial payers treat them as separate providers, each with their own global surgical package. Because of that:

• The Mohs surgeon bills the Mohs codes (17311–17315).

• The plastic surgeon bills the appropriate repair code (simple, intermediate, complex, flap, graft, etc.).

• No modifier (e.g., -58, -59, -79) is required because there is no global period conflict between two different physicians.

This is consistent with standard Mohs billing guidance, which states that repairs performed by a different provider are billed normally and not considered part of the Mohs surgeon’s global package.

*This response is based on the best information available as of 09/03/26.

Are All Injections Billable?

Question:

Patient wants doctor to do injection of BPC 157 [Peptide] which the patient buys and provides. Can I bill 96372 for this service? The BPC 157 is not FDA approved and is considered experimental. Can I bill this service since no J code is available?

Answer:

While CPT 96372 technically describes the mechanical act of giving an injection, billing a payor for non-FDA-approved substances, as you've described, is not recommended. 

*This response is based on the best information available as of 09/03/26.

Posterior Pack for a Nasal Hemorrhage

Question:

I am a new ENT coder, and I am not certain how to bill this. If the emergency department physician placed a posterior pack and they came into our office and one of my doctors removes the pack, can I report CPT code 30906?

Answer:

There is no specific CPT code for removing the posterior pack. If the patient comes back in and one of your physicians removes the pack and does not replace it, you will either report an evaluation and management service or a nasal endoscopy (31231) but not both.

*This response is based on the best information available as of 08/27/26.

Interlaminar vs. Transforaminal Injections

Question:

If my physician does an interlaminar epidural steroid injection with imaging, should I be coding this as a 62321 or 62323? I know the guidelines state if a Transforaminal is done at that level to code as a 64479, but it doesn't state specifically for the interlaminar approach.

Answer:

Ensuring you select the correct injection CPT code is vitally important.

An interlaminar epidural steroid injection, whether performed for diagnostic or therapeutic purposes, is coded to either CPT 62321 or 62323, depending on the anatomic area.

Please note that CPT 62321 is for a cervical or thoracic injection, and CPT 62323 is for a lumbar or sacral (caudal) injection. Both CPT codes include needle or catheter placement with imaging guidance (i.e., fluoroscopy or CT). They do not include neurolytic substances. A transforaminal is coded by CPT 64479.

*This response is based on the best information available as of 08/27/26.

Inferior Dermal Flap

Question:

Is there a code for an inferior dermal flap in breast reconstruction?

Answer:

An inferior dermal flap may be reported using the Adjacent Tissue Transfer (ATT) code set (CPT 14xxx), provided the documentation supports.  According to CPT Assistant guidance, the adjacent tissue transfer codes should be used for a de-epithelialized autoderm flap, based solely on the transposed area.

However, according to Medicare’s National Correct Coding Initiative (NCCI) Policy Manual, adjacent tissue transfer or rearrangement is considered included in breast reconstruction procedures when performed as part of those services.

Excerpt from the NCCI Manual:

“Breast reconstruction procedures (CPT codes 19357–19369) include adjacent tissue transfer or rearrangement procedures (e.g., CPT codes 14000, 14001) if performed. An adjacent tissue transfer or rearrangement procedure may be reported on the same day as a breast reconstruction procedure only if it is performed at a different site unrelated to the breast reconstruction.”

Key Point: According to Medicare guidelines, ATT codes are not separately reportable when performed as part of breast reconstruction, as outlined in the NCCI Manual, Chapter III. If you apply these guidelines universally to all payors, the ATT code would not be reported.

*This response is based on the best information available as of 08/20/26.

Incarcerated Appendix Removed During Inguinal Hernia Repair

Question:

I have a patient who came for repair of incarcerated inguinal hernia. The approach was laparoscopic. A right inguinal hernia was identified. It was found to be containing incarcerated appendix. Attempts to reduce the appendix were unsuccessful with shearing of the serosa. Using scissors with cautery, the peritoneum was opened from the right anterior superior iliac spine to the median umbilical ligament. The contents were dissected off the inferior flap laterally and down to the pubic tubercle medially. The round ligament was dissected off the hernia sac, and the hernia sac was reduced into the abdominal cavity. The appendix was densely scarred in and dissection around the appendix was done until the hernia sac was completely cleared but the appendix did break apart. So, would I code the incarcerated inguinal hernia only or how would I capture the appendectomy?

Answer:

Per CPT, excision and/or repair of strangulated organs or structures are reported in addition to the repair of the strangulated hernia. However, if the appendectomy was performed due to an iatrogenic injury, the treatment of an iatrogenic complication is not separately reportable. Be sure that your documentation is clear in making the distinction between the two scenarios.

*This response is based on the best information available as of 08/20/26.