Pericapsular Nerve Group (PENG) block

Question:

Prior to 2025 we had been instructed to code a Pericapsular Nerve Group (PENG) block to 64999?  What is the best CPT code for a PENG block in 2025?

Answer:

In this procedure, a local anesthetic is injected into the fascial plane located between the psoas tendon and the ilium. This targeted block affects the articular branches of the femoral, obturator, and accessory obturator nerves, which provide sensory innervation to the anterior capsule of the hip.

With the creation of the 2025 CPT codes:

• 64466 – Thoracic fascial plane block, unilateral; by injection(s), including imaging guidance, when performed

• 64467 – Thoracic fascial plane block, unilateral; by continuous infusion(s), including imaging guidance, when performed

• 64468 – Thoracic fascial plane block, bilateral; by injection(s), including imaging guidance, when performed

• 64469 – Thoracic fascial plane block, bilateral; by continuous infusion(s), including imaging guidance, when performed

• 64473 – Lower extremity fascial plane block, unilateral; by injection(s), including imaging guidance, when performed

• 64474 – Lower extremity fascial plane block, unilateral; by continuous infusion(s), including imaging guidance, when performed

CPT Codes 64473 and 64474 now represent the Pericapsular Nerve Group (PENG) block.  The code selection is based on whether an injection or continuous infusion is performed.

*This response is based on the best information available as of 2/13/25.

Skin Cancer Screening

Question:

What is the correct ICD-10-CM code for a skin screening exam for a patient who has a history of malignant melanoma?

Answer:

You should report 2 diagnosis codes; ICD-10-CM Z12.83 for the encounter for malignant neoplasm of skin and Z25.820 (personal history of malignant melanoma of skin).

*This response is based on the best information available as of 2/13/25.

Stent and Atherectomy in the Femoral and Popliteal Arteries

Question:

If a stent is placed in the common femoral artery and an atherectomy is performed in the popliteal artery, can both codes be billed? 

Answer:

The femoral/popliteal is one territory, so angioplasty, atherectomy and stent are reported with one code regardless of the number of interventions performed.  CPT code 37227 represents stent and atherectomy within the same vessel and also includes angioplasty when performed. 

*This response is based on the best information available as of 2/13/25.

Tongue Lesion

Question:

My physician coded a glossectomy but the documentation in the operative report indicated that a tongue lesion was removed. He wants to code 41120 for the glossectomy. I don’t think this meets the definition of a Glossectomy since there was no mention in the operative report that a portion of the tongue was removed.

Answer:

Glossectomy codes require removal of a portion of the tongue, not just the lesion. If your physician is removing a lesion on the tongue, you should report CPT code(s) 41110-41114. When reporting a glossectomy, documentation must include what portion and how much of the tongue was removed. Also be sure to document tongue tissue removal and not just the lesion removal.

*This response is based on the best information available as of 2/13/25.

E&M and Injections: Is this billable?

Question:

We have a new patient presenting for evaluation of new elbow pain following a fall.  The provider documented a full history, exam, ordered and interpreted X-Rays.  Following this evaluation and discussion with the patient, they agreed the best option was to aspirate and inject the joint.  The procedure note documents the aspiration and injection of a corticosteroid. Does this meet the significant, separate service rules to report both the E&M and the aspiration/injection?  

Answer:

Based on the description of the encounter, KZA recommends reporting the E&M-25 and the injection code (20605) and the J code for the drug.  Remember, Medicare requires the JW or JZ modifiers effective July 1, 2023, if the medication was obtained from single-dose package.   Review with your private payors if they are following the same requirement.   

Rationale:  

New problem  

The intent of the visit was not the injection.  

Full E&M service performed.  

Joint decision making with patient on options and to proceed with minor procedure.  

*This response is based on the best information available as of 1/30/25.

Extruded Tympanostomy Tube

Question:

My surgeon removed an extruded tympanostomy tube from a patient’s left ear under general anesthesia.  She wants to code this as 69424-LT for removing the tube.  Can you clarify if this is the correct code?

Answer:

Since the tube has moved from its original intended position and no longer serves the intended purpose, it is considered a foreign body. The correct code to report is 69205 (Removal foreign body from external auditory canal; with general anesthesia).

 Please review the CPT definition of a Foreign Body versus Implant

CPT Surgery Guidelines for “Foreign Body/Implant Definition.”

“An object intentionally placed by a physician or other qualified heal care professional for any purpose (eg, diagnostic or therapeutic) is considered an implant.  An object that is unintentionally placed (eg, trauma or ingestion) is considered a foreign body. If an implant (or part thereof) has moved from its original position or is structurally broken and no longer serves its intended purpose or presents a hazard to the patient, it qualifies as a foreign body for coding purposes unless CPT coding instructions direct otherwise or a specific CPT code exists to describe the removal of that broken/moved implant.”

*This response is based on the best information available as of 1/30/25.