Erector Spinal Block with Discectomy

Question:

Our surgeon states in the procedure title “Fluoroscopic Erector Spinae Block (ESP) L5”. The documentation supports this as performed bilaterally at L5 prior to the surgical incision. Is this separately reportable?

Answer:

Thank you for your inquiry. It appears you have good documentation; however, this block is inclusive of the surgical procedure when performed by the operating surgeon. The timing of this (pre-incision) and fluoroscopically vs post discectomy, does not change the injection as being inclusive.  

*This response is based on the best information available as of 6/19/25.

Ablation of Thyroid Nodules

Question:

My physician performed a percutaneous radiofrequency ablation of 3 thyroid nodules, one in the lower part of the left lobe and 2 in the right lobe. I am not sure what CPT code I should report. Can you help?

Answer:

Certainly. There are 2 new CPT codes to report percutaneous radiofrequency ablation of thyroid nodules: CPT code 60660 (Ablation of 1 or more thyroid nodule(s), one lobe or the isthmus, including imaging guidance, radiofrequency) and CPT code 60661, an add-on code for the additional lobe. In this instance, you will report 60660 for the left lobe and 60661 for the right lobe. Keep in mind that imaging guidance is included and should not be reported separately.

*This response is based on the best information available as of 6/19/25.

Aquaphor and UVB Billing

Question:

Some of our dermatology physicians use Aquaphor as a conductive agent when doing UVB for our psoriasis patients and billing CPT code 96910. We see that Aquaphor is not considered a conductive agent, but we wanted to get your feedback to make sure. Should we use CPT code 96910 or 96912?

Answer:

First, Aquaphor is not a conductive agent.  It is very clear from the CPT guidance that 96910 (photochemotherapy) is reported with tar and ultraviolet B rays (Goeckerman treatment) or petrolatum and ultraviolet B rays. If you use Psolarens, the correct code to report is 96912.   If other substances or no substance is used, you report 96900 (Actinotherapy (ultraviolet light)).  Aquaphor would fall into that category.  

*This response is based on the best information available as of 6/19/25.

Selective or Non-Selective Catheterization

Question:

If we access the dorsalis pedis artery with a catheter and go up into the anterior tibial for arteriogram, is this selective or non-selective?

Answer:

This would be a non-selective catheterization; the access was made and did not cross into the aorta or into another territory for selective catheterization.

*This response is based on the best information available as of 6/19/25.

Flap Creation to Prevent Adhesion to Abdominal Wall

Question:

Can I separately bill for an omental flap or peritoneal flap when the surgeon performs the flap to prevent adhesion to the abdominal wall after a hernia repair or colon resection?

Answer:

No, you cannot bill separately for the omental or peritoneal flap. Using flaps to prevent adhesion to the abdominal wall is considered part of the closure and would not be separately reported.

*This response is based on the best information available as of 6/19/25.

Amount of Lamina Removed for a Laminectomy

Question:

I'm pretty new to neurosurgery coding and could use some help. Is there a specific amount or percentage of lamina that must be removed in order to code 63047?

Answer:

No. Surgeons usually try to remove as little lamina as possible – just enough to relieve pressure on the nerve. A specific amount does not need to be documented.

*This response is based on the best information available as of 6/19/25.