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.

Intraoperative Nerve Stimulation

Question:

We are having difficulty locating a code. One of our hand surgeons is performing therapeutic nerve stimulation intraoperatively for regeneration of nerve. Is this reportable, and if yes, what is the code?

Answer:

Great question and thank you for asking us!

Two new Category III CPT codes have been introduced: 0882T and 0883T. These codes became effective on July 1, 2024, and are included in the 2025 CPT manual.

• 0882T – Intraoperative therapeutic electrical stimulation of a peripheral nerve to promote nerve regeneration, including lead placement and removal, upper extremity, minimum of 10 minutes; initial nerve

• 0883T – Intraoperative therapeutic electrical stimulation of a peripheral nerve to promote nerve regeneration, including lead placement and removal, upper extremity, minimum of 10 minutes; each additional nerve

Key points to note about these Category III codes:

• They are specific to the upper extremity

• Require a minimum of 10 minutes of stimulation

• Are add-on codes and must be reported in conjunction with a primary procedure

*This response is based on the best information available as of 8/14/25.

ICD-10 - Skin Necrosis Following Breast Reconstruction

Question:

I’m having difficulty with the ICD-10 code assignment. Can KZA provide some guidance? A patient following breast reconstruction presented during the postoperative period with skin necrosis at the incision site.

Answer:

Thank you for your question!

Based on the information provided, two ICD-10 codes would be reported: one for the postoperative complication of the skin and subcutaneous tissue, ICD-10 L76.82, and one for skin necrosis, ICD-10 I96.

Some may stop at L76.82 alone. However, ICD-10 provides additional instruction located under L76.8. The instruction states, “Use additional code, if applicable, to further specify the disorder.”

*This response is based on the best information available as of 7/31/25.

Wound Vac Billing

Question:

Can a wound vac be billed if a wound is partially sutured and partially left open?

Answer:

Billing for a wound vac depends on whether the wound is considered open or closed. According to coding guidelines, negative pressure wound therapy (NPWT) codes (97605-97608) are only reportable when placed at an open wound site. If a wound is partially sutured but still has an open portion, the wound vac may be billable, provided the documentation supports its use for the open wound. However, if the wound vac is applied over a closed wound, it is generally considered a dressing and not separately billable.

To ensure proper billing, documentation should clearly indicate the wound's size, depth, and the necessity of NPWT. Some payors may have specific rules, so checking with the relevant insurance provider or Medicare guidelines is recommended.

*This response is based on the best information available as of 7/17/25.

Muscle Flap Denial

Question:

We received a denial for a muscle flap. We appealed, and unfortunately, the denial was upheld due to the documentation. Can KZA provide some insight?

Answer:

Thank you for your inquiry.

The operative note was not included in this inquiry. Documentation should support flap elevation, identification, and preservation of the blood supply (naming the pedicle/ identifying the vein and artery), transfer and inset of the flap, and donor site closure.

Documenting the details is essential – these codes are being scrutinized more closely!

*This response is based on the best information available as of 7/03/25.

Free Nipple Grafts with Breast Reduction

Question:

In the setting of breast reduction, when free nipple grafts are done, is this separately reportable?

Answer:

No – it would not be appropriate to report CPT 15200 for the harvest of the nipple areola complex for free graft. This work is considered included in CPT 19318 for breast reduction and therefore not separately reportable.

For the scenario as described, the appropriate CPT to report is only 19318.

*This response is based on the best information available as of 6/19/25.