Closure After a Partial Mastectomy, Code 19301

Question:

Adjacent tissue transfers, 14000 series to include 14301 and 14302 with 19301 Mastectomy. I see where you clarify 14000 (ADJ flaps) to eliminate dead space is inherent to a mastectomy procedure. My question is does this include codes 14301 and 14302? I'm asking because there was a Q & A 2017 CPT Assistance Article stating "14000 and 14001 are not reported separately because simple, intermediate and complex layered closure is included in the work represented by code 19301". As such, our guidance is that it is ok to bill separately for codes 14301 and 14302 with 19301 when the defect is larger than 30 sq cm.

Answer:

This is a common misunderstanding. It does not matter how large a defect remains after a partial mastectomy, closure by a local advancement flap or an oncoplastic repair do not support an adjacent tissue transfer. Codes 14301, 14302 should not be reported for these closures regardless of the size of the defect.

See below for guidance from the American College of Surgeons national coding courses.

• There are no additional codes for closure after a partial mastectomy, code 19301

• Elimination of dead space is inherent to a mastectomy procedure.

• Complex closure (13100-13102, 13131-13133) is included in any mastectomy procedure.

• Local advancement flaps and oncoplastic repair are included in a mastectomy procedure.

• Adjacent tissue transfer (ATT) (14000-14302) is not commonly performed with a mastectomy (e.g., 19120, 19125). A closure defined as a local advancement flap or an oncoplastic repair is most commonly a skin advancement flap that does not meet the definition of a true ATT.

• If a complex repair is substantially greater than typically required, it may be appropriate to append modifier 22, Increased Procedural Services, to the mastectomy code. Documentation must support the substantial additional work and the reason for the additional work (i.e., increased intensity, time technical difficulty of the procedure, severity of patient’s condition, physical and mental effort required.

*This response is based on the best information available as of 12/04/25.

KX Modifier?

Question:

Should the KX modifier be billed on all feminization procedures in the setting of gender dysphoria? For example, feminization rhinoplasty for a trans female patient assigned male at birth.

Answer:

In the context of gender-affirming surgery, the KX modifier should be appended to procedure codes that are gender-specific—particularly when there is a mismatch between the patient’s gender marker and the procedure or diagnosis code. This modifier alerts the payer that the coding is intentional and not an error.

In the example provided—feminization rhinoplasty for a trans female patient—there is typically no conflict between the gender marker and the procedure or diagnosis code. As such, the KX modifier would generally not be necessary.

It’s important to note that modifier KX indicates that “requirements specified in the medical policy have been met.” This modifier is not exclusive to gender-affirming procedures and may be used in other contexts.

In closing, always consult the payer-specific policy and your internal coding compliance guidelines to ensure accurate and compliant use of modifiers.

Thank you for contacting KZA!

*This response is based on the best information available as of 11/20/25.

Automated Skin Cell Suspension Autograft Procedures

Question:

A provider at our facility has begun performing the new 2025 skin cell suspension autograft procedure. During this process, automated preparation of the autograft is performed, including enzymatic processing, disaggregation of skin cells, and filtration of harvested tissue. Currently, there is no specific CPT code that describes this work. Since we are advised to report an unlisted code for this service, what comparative CPT code would you recommend using to help determine appropriate reimbursement?

Answer:

For SCSA procedures using automated preparation devices, report the harvest codes (15011-15012) and application codes (15015-15018) based on the surface areas involved. Do not report the preparation codes 15013-15014 when automated devices are used, as these codes are exclusively reserved for manual mechanical disaggregation of skin cells.

According to CPT Assistant (December 2024, June 2025), the Skin Replacement Surgery subsection guidelines explicitly state that codes 15013-15014 "are not reported if the harvested skin is nonmanually processed (i.e., using automation)." When automation is used, only the physician's work in harvesting and application is separately reportable.

*This response is based on the best information available as of 11/06/25.

14000 and 19301 for Partial Mastectomy?

Question:

Should cpt code 14000 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10 SQ CM be billed with cpt code 19301 MASTECTOMY; PARTIAL? Insurances tend to disallow it stating it is included in 19301. This is how our surgeon describes 14000, a parenchymal flap advancement was used to close, there is minimal breast parenchyma left at the inferior margin. Advancing this into the lumpectomy cavity does create some distortion along the inframammary fold. Therefore, the breast tissue both above and below the lumpectomy cavity is released from the underlying chest wall. They form a well vascularized broad based pedicle. This is advanced into the lumpectomy cavity and secured together with interrupted 3-0 Vicryl sutures. Approximately 10 sq cm of tissue are mobilized in this fashion. Thank you for your help.

Answer:

No, 14000 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10 SQ CM is not reported with a partial mastectomy (lumpectomy) code 19301 for a local advancement flap, which is what is described in your question

Elimination of dead space is inherent to a mastectomy procedure. Local advancement flaps and oncoplastic repair are included in a mastectomy procedure.

*This response is based on the best information available as of 10/23/25.

Pyogenic Granuloma

Question:

Hello! Could KZA clarify if the excision of a pyogenic granuloma (lobular capillary hemangioma) would be assigned to a code from the musculoskeletal or integumentary system? We have seen some conflicting information.  

Answer:

Thank you for reaching out to KZA!

The origin of the lesion will direct you to the appropriate code selection.

According to CPT:

• Lesions of cutaneous origin are appropriately reported with the excision of lesion integumentary codes (114xx & 116xx).

• Lesions of non-cutaneous origin are appropriately reported with the excision of tumor codes from the musculoskeletal section of CPT (2xxxx).

Pyogenic granulomas are benign, generally considered of cutaneous origin, and reported with a 114xx benign lesion code. If the documentation is unclear, it is best practice to query the surgeon for clarification.

*This response is based on the best information available as of 10/09/25.

Secondary Closure?

Question:

I’m a new coder, and my physician closed a fasciotomy wound. I’m unsure what to do with this, so I am seeking some much-needed guidance. I’m looking at 13160. The surgeon debrided tissue and closed the wound.

Answer:

Thank you for reaching out—great job identifying CPT 13160. You're on the right track. If this is a secondary closure of a fasciotomy wound, CPT 13160 (Secondary closure of surgical wound or dehiscence) is appropriate.

*This response is based on the best information available as of 10/09/25.