Synthetic Graft to Close Dura

Question:

After performing a craniotomy for tumor removal, the dura was repaired with a synthetic graft. What code is used for the synthetic graft?

Answer:

Repairing the dura after a craniotomy with a synthetic graft is included in the craniotomy code. No additional code is reported.

*This response is based on the best information available as of 4/10/25.

Laparoscopic Mobilization of Splenic Flexure With Open Colectomy

Question:

Our provider began a laparoscopic procedure for colectomy and completed the mobilization of the splenic flexure laparoscopically, but then needed to convert to an open procedure to perform the colectomy. What is the correct coding for laparoscopic mobilization of the splenic flexure with open colectomy?

Answer:

When a laparoscopic procedure is converted to an open procedure, you can only code for the open procedure, so in this case, only code for the appropriate open colectomy code; the laparoscopic mobilization of the splenic flexure is not separately billable.

*This response is based on the best information available as of 4/10/25.

EAC Closure Coding

Question:

Is a "blind sac EAC closure" included in codes 69603 and 69530? Or would the closure be billed separately?

Answer:

Thank you for your question.

CPT codes 69603 and 69530 do not include a "blind sac closure" of the external auditory canal (EAC).

• CPT code 69603 is for a tympanoplasty with mastoidectomy, which includes a meatoplasty (widening of the ear canal entrance) but not a blind sac closure

• CPT code 69530 is for a radical mastoidectomy, which also does not include a blind sac closure

A blind sac closure is a separate procedure involving the permanent closure of the external auditory canal, and it would need to be coded separately. This would be reported with the unlisted code 69399 since there is no specific code for this procedure. You can use CPT 69603 or 69530 as the comparison code.

*This response is based on the best information available as of 4/10/25.

Clarifying Nerve Injection Coding: CPT 64451 vs. 64450

Question:

Hi KZA, I am new to pain management coding. If I’m injecting the L5, S1, S2, and S3 nerves, do all four have to be injected in order to report code 64451 appropriately? Could code 64451 still be reported if only one or two nerves are injected?

Answer:

All four nerves must be injected in order to report code 64451, Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (i.e., fluoroscopy or computed tomography).

The injection targets the L5 dorsal ramus nerve at the junction of the sacral ala and S1 superior articular process. In turn, the S1, S2, and S3 nerves are injected at the posterior lateral foramen of the S1, S2, and S3 foramen. CPT 64451 has an MUE of 1.

If only one or two nerves or branches were injected, code 64450, Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch, may be reported with one or two units, respectively. Follow your individual third-party payor’s guidelines for appropriate modifier usage when each subsequent unit of 64450. CPT 64450 has an MUE of 10.

*This response is based on the best information available as of 4/10/25.

First Visit for a Chronic Condition

Question:

I am seeing a patient for the first time in the office and they are reporting to me that they have had psoriasis for over two years and their symptoms are worsening; is this problem a level 3 (99203) or 4 (99204)?

Answer:

If your documentation indicates the patient has a chronic condition that is worsening, then the complexity of the problem addressed is moderate, even if this is their first visit to you. However, keep in mind there are three elements to Medical Decision Making:

• Complexity of Problem(s) Addressed

• Amount and/or Complexity of Data to be Reviewed or Analyzed

• Risk of Mortality and/or Morbidity of Patient Management

Two of the three elements on the risk table must be met.  For example, if the condition managed is chronic psoriasis worsening and you write a prescription for a topical medication, the complexity of the problem addressed is moderate with moderate risk. This would indicate a level four new patient visit (99204).

*This response is based on the best information available as of 4/10/25.

Destruction of Seborrheic Keratosis

Question:

I have a patient encounter. I need to code for a patient with 3 SK’s, 2 on the right forearm and 1 on the left forearm. The physician froze the lesions. I am thinking I should code 17000 x 1 and 17003 x 2. Is this correct?

Answer:

The correct CPT code to report for destruction of SK’s is 17110 (destruction benign lesions other than skin tags or cutaneous vascular proliferative lesions up to 14). You will only report CPT code 17110 with 1 unit since the code includes 1-14 lesions. CPT codes 17000-17004 is used to report the destruction of premalignant lesions for example an AK (actinic keratosis).

*This response is based on the best information available as of 3/27/25.