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Intraoperative Nerve Stimulation
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?
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
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.
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
Can a wound vac be billed if a wound is partially sutured and
partially left open?
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
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?
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
In the setting of breast reduction, when free nipple grafts are done, is this separately reportable?
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.
Coding for Goldilocks
How do I code for a “Goldilocks” Reconstruction?
Question:
How do I code for a “Goldilocks” Reconstruction?
Answer:
KZA would like to thank you for this great question!
In the “Goldilocks” procedure, what remains of skin following a mastectomy is used to create a breast mound.
The ASPS advises using an adjacent tissue transfer code (ATT 14XXX), with the dimension based only on the inferior tissue that is separately incised and transferred to create the breast mound. They also describe this procedure as “similar to” an autoderm flap.
In a CPT Assistant from April 2021, there is an instruction to report the adjacent tissue transfer codes for reporting a de-epithelialized autoderm flap based only on the transposed area.
To assign the appropriate code for the Goldilocks procedure, the dimension based only on the inferior tissue that is separately incised and transferred should be documented clearly. The remaining skin closure is considered included.
*This response is based on the best information available as of 6/05/25.
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