Benign Lesion Destruction

Question:

My provider destroyed 5 lesions on the penis, and then 5 lesions on the scrotum and groin area. Can I code 54056 and 17110?

Answer:

Thank you for your question. The destruction of the lesions on the penis are via cryosurgery you will report CPT code 54056. In addition, you may report CPT 17110 for the lesion destructions on the scrotum and groin area. Since the two services are not bundled under NCCI Modifier 51 should be appended to CPT code 17110

*This response is based on the best information available as of 12/04/25.

Closure After a Partial Mastectomy, Code 19301

Question:

Adjacent tissue transfers, 14000 series to include 14301 and 14302 with 19301 Mastectomy. I see where you clarify 14000 (ADJ flaps) to eliminate dead space is inherent to a mastectomy procedure. My question is does this include codes 14301 and 14302? I'm asking because there was a Q & A 2017 CPT Assistance Article stating "14000 and 14001 are not reported separately because simple, intermediate and complex layered closure is included in the work represented by code 19301". As such, our guidance is that it is ok to bill separately for codes 14301 and 14302 with 19301 when the defect is larger than 30 sq cm.

Answer:

This is a common misunderstanding. It does not matter how large a defect remains after a partial mastectomy, closure by a local advancement flap or an oncoplastic repair do not support an adjacent tissue transfer. Codes 14301, 14302 should not be reported for these closures regardless of the size of the defect.

See below for guidance from the American College of Surgeons national coding courses.

• There are no additional codes for closure after a partial mastectomy, code 19301

• Elimination of dead space is inherent to a mastectomy procedure.

• Complex closure (13100-13102, 13131-13133) is included in any mastectomy procedure.

• Local advancement flaps and oncoplastic repair are included in a mastectomy procedure.

• Adjacent tissue transfer (ATT) (14000-14302) is not commonly performed with a mastectomy (e.g., 19120, 19125). A closure defined as a local advancement flap or an oncoplastic repair is most commonly a skin advancement flap that does not meet the definition of a true ATT.

• If a complex repair is substantially greater than typically required, it may be appropriate to append modifier 22, Increased Procedural Services, to the mastectomy code. Documentation must support the substantial additional work and the reason for the additional work (i.e., increased intensity, time technical difficulty of the procedure, severity of patient’s condition, physical and mental effort required.

*This response is based on the best information available as of 12/04/25.

Injections and E/M Visits

Question:

How do you code for an unplanned injection as well as the E&M service necessary to make the decision to perform the injection?

Answer:

The answer to this question depends upon if you are providing a significant and separate evaluation and management service in addition to an injection, and not whether the injection was planned or unplanned.  Every minor procedure has time for pre-service evaluation included in the value of the procedure code. Medicare and other payors have become concerned that E/M’s are being routinely reported with minor procedures without considering if the extent of the visit was truly more than the pre-service evaluation already included in the procedure. Just because an injection is unplanned does not automatically allow for an E/M visit to be billed. There must be a significant and separately identifiable E/M service above and beyond the injection. Please listen to our KZA KAST Modifier Monday podcast on Modifier 25 for additional information.

https://monday.transistor.fm/

*This response is based on the best information available as of 11/20/25.

0232T

Question:

Hi. We would like a little guidance on what is included in the PRP code 0232T. If the PRP injection is rendered in a tendon and a tendon fenestration/tenotomy is performed, is the fenestration included in the PRP code? Also, if PRP is being utilized to hydrodissect a tendon, is the hydrodissection included in the PRP injection?

Answer:

Thank you for asking KZA!

After creating platelet-rich plasma (PRP) from a patient’s blood sample, that solution is injected into the target area, such as an injured knee or a tendon. In some cases, the clinician may use ultrasound to guide the injection. The purpose is to promote and/or accelerate the healing process of the tendon and tissue regeneration. 

Both fenestration and hydro-dissection are also performed to promote healing of the tendon and surrounding tissue, and when performed in conjunction with PRP injection, should not be reported separately.  

*This response is based on the best information available as of 11/20/25.

63267 or 22102?

Question:

A patient presents with lumbar discitis and osteomyelitis, and the provider performs a laminectomy with debridement of the disc and bone. Which CPT code is more appropriate in this scenario: 63267 or 22102?

Answer:

Thank you for asking!

In this case, the procedure involves a lumbar laminectomy with debridement of both disc and bone due to infectious pathology. CPT code 63267 is the correct choice, as it describes a lumbar laminectomy for excision or evacuation of an extradural intraspinal lesion other than a neoplasm. Code 22102 applies to the partial excision of the posterior vertebral component, which does not accurately reflect the work performed.

*This response is based on the best information available as of 11/20/25.

Pediatric ENT Consultation

Question:

Our internal compliance team states that our pediatric otolaryngologists should never bill for a consultation. This is because the description in the 2025 CPT states "Services that constitute a transfer of care (i.e. are provided for the management of the patient's entire care or for the care of a specific condition or problem) are reported with the appropriate new or established patient codes." I have explained that when a pediatrician refers a patient to us for ear infections, we give our opinion on what treatment is needed, perform surgery and then send the patient back to the pediatrician. If the patient has another ear infection, we ask that they see their pediatrician for management of the acute infection. I argue that what we do does not constitute a "transfer of care". They suggested I reach out to KZA for clarification. Thank you!

Answer:

CPT 2025 has removed previous language related to "transfer of care" from the consultation code section. Most payors no long accept consultation codes and require you to use problem-oriented E/M codes, but there still a few payors who pay for consults. CPT now emphasizes that consultation codes can be used when the criteria for a consult are met, regardless of whether the patient is new or established.

According to CPT, a consultation is appropriate when:

• A physician requests another physician’s opinion or advice regarding diagnosis or treatment.

• The consulting physician provides that opinion and communicates back to the requesting physician.

• The consulting physician does not assume ongoing care for the condition.

The pediatrician refers the patient for evaluation and possible surgical treatment in your case. Your team provides an expert opinion, performs the surgery, and then returns the patient to the pediatrician for ongoing care. You do not manage the patient’s long-term treatment for recurrent infections. This aligns with the definition of a consultation rather than a transfer of care. The fact that you send the patient back to the referring provider and do not assume continuous management supports your use of consult codes.  It is important to check with your individual payor to determine if they accept consultation codes or if they require problem-oriented E/M codes. 

*This response is based on the best information available as of 11/20/25.