Documentation to Support Modifier 22

Question:

When performing spinal procedures, does documentation of obesity support the use of modifier 22?

Answer:

Documentation of obesity alone does not support the use of modifier 22, however, additional information indicating the patient’s obesity resulted in a procedure that was technically more difficult, or required more time than normal (i.e., suggesting that the neck was thick, positioning was difficult, more time was spent), could support the use of modifier 22.

*This response is based on the best information available as of 4/24/25.

Arthrodesis With Local Graft

Question:

What is the appropriate CPT code to report when local autograft is used and taken from the reamings and allograft is used for arthrodesis of the IP joint? Which CPT code is correct, 26862 or 26860?

Answer:

Thank you for your question.

CPT 26860 includes using locally obtained autograft bone in addition to the allograft. In contrast, CPT code 26862 is reported when an autograft is obtained from a separate site and is valued for the additional work involved in obtaining that graft from a separate anatomical location.

Based on the question and presented scenario, the correct CPT code is 26860.

*This response is based on the best information available as of 4/24/25.

Soft Tissue Tumors

Question:

My physician told me to use CPT code 21011 for an excision of a 1.2 cm cutaneous basal cell carcinoma on the scalp. Is this correct?

Answer:

This is a great question. You only use soft tissue tumor codes for the excision of non-cutaneous origin tumors such as lipomas, sarcomas, and hemangiomas. For cutaneous lesions such as basal cell carcinoma 1.2 cm, you would report 11622 (excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm). For any excision of a cutaneous lesion, they are reported as malignant excisions (116xx) based on anatomic area and cm size.

*This response is based on the best information available as of 4/24/25.

E/M for an Acute Problem

Question:

How do we code for a new patient seen in the office with RUQ upper quadrant discomfort with suspected cholecystitis and an order for ultrasound?

Answer:

A new patient with an acute problem (or “suspected” may be viewed as undiagnosed), with minimal data (order) and minimal/low risk for the ultrasound, would be 99203.

*This response is based on the best information available as of 4/24/25.

Consultation Request by Another Specialty

Question:

Cardiology performs a procedure on an inpatient, and later in the day, the patient develops a pseudoaneurysm. When vascular is called in to evaluate the patient, can vascular bill for the evaluation?

Answer:

Yes, vascular can bill for an appropriate level E/M inpatient or consultation. The cardiologist is requesting the skill of a vascular surgeon to evaluate a vascular condition that is separate from the preceding cardiology procedure (i.e., complication).

*This response is based on the best information available as of 4/24/25.

Iliac Angioplasty and Stent Coding: Per Vessel or Per Lesion?

Question:

The surgeon documented angioplasty and stents for occlusive disease in the right common and external iliac arteries. Is this reported with one or two codes?

Answer:

That depends! Coding is reported per lesion, not per vessel. So, if a single lesion extends across the two iliac vessels, external and common, only one code is reported, 37221. However, if two separate and distinct lesions are in these two vessels, separately treated with angioplasty and stents, then two codes may be reported, 37221 and +37223. Documentation of two separate and distinct lesions will be key!

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