Abdominal Hernia Defect Size

Question:

Our general surgeon often does not include the size of the abdominal repair in his documentation; can we use the pathology report to determine the correct size for CPT selection?

Answer:

No; the provider must document the hernia defect size within his/her operative report details to accurately select the correct CPT code. The pathology report would likely represent the tissue size, which would not necessarily correlate to the defect size. Best practice is to send a query to the provider asking him/her to add an addendum to the operative report, adding the defect size and advise that this information is required in the documentation.

*This response is based on the best information available as of 2/27/25.

Use of Robotic Systems During Surgical Procedures

Question:

What is the code for a robotic procedure?

Answer:

When surgical procedures involve the use of robotic surgical systems, the robotic component can be represented by HCPCS code S2900. However, there is no RVU associated with this code, and it is not reimbursed under the Medicare payment system. Best practice is to set a fee for the extra physician work involved with robotic assistance, document medical necessity for use of the robot and incorporate this code into billing for tracking purposes, when used.

*This response is based on the best information available as of 2/27/25.

Non-Selective vs Selective Catheterization

Question:

What is the difference between non-selective and selective catheterization?

Answer:

Non-selective catheterization is when the catheter remains in the accessed vessel site (puncture site) and is not navigated further into other vessels. Selective catheterization is when the catheter is manipulated out of the access vessel, or out of the aorta, to additional vessels.

*This response is based on the best information available as of 2/27/25.

Bone Marrow Harvest for Ankle Arthrodesis

Question:

Our surgeon harvested bone from the calcaneus (same incision) and also harvested bone marrow from the iliac crest for an ankle arthrodesis. We know the bone graft from the calcaneus is not reportable. Is the bone marrow aspirate reportable? If yes, what CPT code do you recommend?

Answer:

You are correct that bone graft harvested via the same incision is not separately reportable. CPT instructs to report 20999 for the bone marrow harvest when performed for an arthrodesis in musculoskeletal system, excluding spine.

Based on your inquiry the correct code for the ankle arthrodesis is 27870 (Arthrodesis, ankle, open). Your reportable codes are 27870 and 20999.

Note, there are no NCCI edits between 27870 and 20999. Consider adding modifier 59 if necessary to indicate the bone marrow aspirate was from a different location, separate incision.

KZA recommends using 20939 as the comparison code for 20999.

*This response is based on the best information available as of 2/27/25.

A Follow-up Question on Scar Revision

Question:

I reviewed your updated coding coach on scar revision and have a follow-up question. What if the scar was revised with an adjacent tissue transfer (ATT)?

Answer:

Thank you for your follow-up question!

Providing the requirements for reporting an adjacent tissue transfer (ATT) have been met and the adjacent tissue transfer is documented appropriately the ATT can be reported.

The CPT guidelines for adjacent tissue say that the term defect includes primary and secondary defects; the primary defect results from the excision, and the secondary defect results from the flap design.

The primary and secondary defects should each be documented separately in centimeters (cm); both measurements are added together to arrive at the total sq cm, allowing for appropriate code.

*This response is based on the best information available as of 2/27/25.

Interspace Between the Popliteal Artery and Capsule of the Posterior Knee (iPACK) Block

Question:

KZA, thank you for the information on the Coding Coach on the PENG block.  Do the same CPT codes apply to an interspace between the Popliteal Artery and Capsule of the posterior Knee (iPACK) block?

Answer:

While the Pericapsular Nerve Group (PENG) targets the anterior capsule of the hip, the iPACK block focuses on the posterior knee joint.

The creation of CPT codes 64466 – 64474 describes blocks performed in the fascial plane and distinguishes the fascial plane blocks from a nerve block.

CPT codes 64473 and 64474 are used for the infiltration of the interspace between the Popliteal Artery and the capsule (iPACK) block. The applicable code will depend on whether an injection or continuous infusion is 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

*This response is based on the best information available as of 2/27/25.