Are Superior Labrum Tears coded to CPT 29806 or 29807?

Question:

Would 29807 or 29806 be reported for a repair of the superior anterior labrum without posterior extension? There is some confusion regarding the term "Superior" as being a qualifying factor pointing towards 29807 vs. 29806. Does the location of the tear being "Superior" qualify the tear to be reported with 29807 vs. 29806 regardless of whether both the anterior and posterior portions of the superior labrum were torn and repaired? The snippet of the operative report in question below documents only the anterior portion of the superior labrum was torn and repaired.

• "Diagnostic arthroscopy was performed. A tear of the anterior superior labrum was confirmed on diagnostic arthroscopy. The remainder of the labrum was intact. Attention was then turned to the repair of the anterior superior labrum and the labral cyst. The anterior superior glenoid was first debrided and the margin of the glenoid was debrided with the use of shave. Once bony bleeding had been achieved, attention was turned to placing the suture anchors. A total of two anchors were placed in a mattress stitch configuration, positioned anterior‑superiorly and superiorly.”

Answer:

I find that reviewing the labrum as a clock helps determine the best coding. To avoid confusion, as you present here, operative note dictation describing where the anatomic location of the tear is also beneficial.

With that said, the term "superior" is not necessarily the qualifying factor for selecting either CPT 29807 vs. 29806. As if you are looking at a clock, the SLAP tear occurs between the 11 (posterior) and 1 (anterior) positions. The anterior superior labrum is between the 1 and 3 position, therefore it is likely that a tear in the anterior superior labrum can be coded to 29807.

*This response is based on the best information available as of 06/04/26.

eTEP Hernia Repairs

Question:

Our provider is doing hernia repairs with an eTEP which was explained to me as a myofascial advancement. Is this separately billable or is it considered bundled to the hernia repair?

Answer:

eTEP (extended or enhanced view totally extraperitoneal) describes the surgical approach utilized for the procedure. The coding for anterior abdominal hernia repair remains the same regardless of the approach performed. The appropriate repair code should be selected based on whether the hernia is initial or recurrent, as well as the total defect size.

*This response is based on the best information available as of 06/04/26.

SI Joint Injection in an ASC Coding

Question:

Does Medicare require a different code than 27096 for SI joint injections billed to an ASC?

Answer:

Yes. For ASC (Ambulatory Surgery Center) billing, Medicare requires HCPCS code G0260 instead of 27096. For professional (physician) billing, 27096 is used for Medicare. Many commercial payors also accept 27096. Always verify payor-specific requirements.

*This response is based on the best information available as of 06/04/26.

Coding for a Fess Procedure

Question:

What is the recommended CPT coding for a nasal/sinus endoscopy with a total ethmoidectomy, frontal sinus exploration with removal of tissue from frontal sinus, a sphenoidotomy with removal of tissue from sphenoid, and a maxillary antrostomy with removal of tissue from maxillary sinus?

Answer:

For a functional endoscopic sinus surgery (FESS) involving the procedures you listed, the recommended CPT codes are:

• Total ethmoidectomy (anterior + posterior): 31259 – Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior and posterior) including sphenoidotomy, including removal of tissue from the sphenoid sinus.

• Frontal sinus exploration with removal of tissue: 31276 – Nasal/sinus endoscopy, surgical; with frontal sinus exploration, including removal of tissue from frontal sinus.

• Maxillary antrostomy with removal of tissue: 31267 – Nasal/sinus endoscopy, surgical; with maxillary antrostomy, with removal of tissue from maxillary sinus.

CPT code 31259 is a combination code that includes anterior and posterior ethmoidectomy and the sphenoidotomy which includes the removal of tissue from the sphenoid sinus. These codes are separate and distinct procedures because they involve different sinus cavities, so they are typically reportable together (when medically necessary and documented). If performed bilaterally, append modifier -50 (or follow payer-specific bilateral reporting rules). The “with removal of tissue” codes (31267, 31276, 31259) are appropriate since tissue removal is documented. Do not separately report diagnostic endoscopy (31231) — it is included in the surgical procedures.

*This response is based on the best information available as of 06/04/26.

Biopsy of Lip

Question:

A provider performed a shave biopsy of the vermillion border using a dermablade. Would you report 11102 or 40490 for cases like this? What warrants reporting CPT Code 40490?

Answer:

Thank you for your question. For a shave biopsy of the lip skin or vermillion border performed with a dermablade, 11102 is the correct code. CPT 11102 covers tangential (shave/scoop/curette) biopsies of skin and skin appendages, which includes the cutaneous lip and vermillion. A dermablade is the classic instrument for a tangential/shave technique, which maps directly to the 11102 description. The lip, for integumentary coding purposes, is treated as a skin site when the biopsy involves the surface epithelium/vermillion using a shave technique

In order to report CPT code 40490 (biopsy of lip), the biopsy requires incisional technique into the deeper lip tissue (submucosa, muscle). The lesion is on the mucosal surface of the lip (wet mucosa, not vermillion or skin). A punch or excisional approach is used on the lip mucosa and the clinical intent is to sample submucosal pathology (e.g., suspected mucocele, minor salivary gland lesion, deeper fibrosis).

*This response is based on the best information available as of 06/04/26.

ICD-10 – Defect following Mohs

Question:

Can you please advise? Our practice performs reconstructions of defects following Mohs surgery. For context, we typically evaluate the patient prior to surgery to discuss reconstruction. What is the appropriate ICD-10 coding to reflect this wound in the setting of reconstruction?

Answer:

To accurately report this scenario, multiple ICD-10 codes are required:

1. Z48.1 - Encounter for planned postprocedural wound closure.

2. Z42.8 - Encounter for other plastic and reconstructive surgery following a medical procedure.

A third ICD-10 code should be selected based on the patient’s diagnosis history, specifically whether there is an active malignant neoplasm or a personal history of neoplasm.

Example: Same Day Mohs surgery and reconstruction

1. Z48.1 – Encounter for planned postprocedural wound closure.

2. Z42.8 – Encounter for other plastic and reconstructive surgery following a medical procedure.

3. Appropriate C-code for the malignancy.

Key Considerations:

• The malignancy code is not listed as the primary diagnosis because the service being performed is reconstruction, not treatment of the cancer.

• Codes from Chapter 19 of ICD-10 (S00–T88, injury range) are not appropriate, as they are designated for traumatic injuries and do not apply in this clinical context.

Thank you for reaching out to KZA with your inquiry.

*This response is based on the best information available as of 06/04/26.