Bone Marrow Aspirate

Question:

Good afternoon,
One of our physicians is performing an injection of bone marrow aspirate concentrate into infraspinatus, supraspinatus tendons and the glenohumeral joint, under ultrasound guidance. Bone marrow was aspirated from bilateral iliac crests under US guidance and processed via centrifugation. How should this be reported?
Thank you

Answer:

CPT Category III code 0232T was introduced in 2010 for reporting injection of platelet rich plasma to a targeted site; the code definition includes all harvesting, preparation, and image guidance for the service. In August 2010 the AAOS published guidance in AAOS Now which explained “The new code is to be used only when PRP is performed in a complete separate patient encounter from a surgical procedure.”

Based on this direction, when PRP is injected during another procedure, whether using drawn blood or bone marrow aspirate, it is not separately reportable with the primary surgical service.

If PRP injection is the only service performed, then 0232T is the correct code. In recent years some physicians have begun using bone marrow aspirate harvested from the iliac crest instead of drawn blood for PRP preparation, and reporting the harvesting using CPT code 38220. The May 2012 edition of CPT Assistant clarified that 0232T is the only code reportable for PRP injection, whether performed using drawn blood or harvested bone marrow aspirate. In 2018 the definition of 38220 was changed to reflect that it should be used only for diagnostic bone marrow aspiration. New code 20939 should be used when bone marrow aspiration is performed for bone grafting, for spine surgery only, via a separate incision. CPT instructs to use 20999 for bone grafting, other than spine surgery and other therapeutic musculoskeletal applications.

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

Appropriate CPT Coding for OLLIF

Question:

I have a provider who wants to code 22558 for a procedure that is done posterior only. I am coding as TLIF, posterior interbody fusion with posterolateral fusion and Laminectomy, facetectomy, foraminotomy for decompression with discectomy. He states this is OLLIF not OLIF but still wants 22558. There is no repositioning of the patient. He does not enter the retroperitoneal space. All incisions are done posteriorly. Any guidance?

Answer:

Neither CPT 22558 nor CPT 22633 is appropriate for reporting an OLLIF procedure.

CPT 22558 describes an anterior interbody fusion and requires an anterior or anterolateral approach, typically involving retroperitoneal or transabdominal access. Since OLLIF is performed via a posterior-only, percutaneous approach, it does not meet the criteria for this code.

CPT 22633 describes a posterior interbody fusion combined with posterolateral fusion, typically used for TLIF procedures. However, OLLIF is a distinct technique that does not involve the same surgical exposure or instrumentation as TLIF.

According to CPT Assistant, June 2020, Volume 30, Issue 6, page 14: There is no specific CPT code that accurately describes the OLLIF procedure. Therefore, unlisted code 22899, Unlisted procedure, spine, should be reported. When reporting an unlisted code to describe a procedure or service, it is necessary to submit supporting documentation (e.g., procedure report) with the claim to provide an adequate description of the nature, extent, and need for the procedure, as well as the time, effort, and equipment necessary to provide the service.

Using 22899 ensures accurate representation of the surgical technique and compliance with AMA coding guidance, helping avoid potential denials or audits.

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

Bundling of Drug-Induced Sleep Endoscopy and Turbinate Procedures

Question:

Can you explain why the sleep endoscopy 42975 and any turbinate procedure is bundled? The procedures are done for two completely different reasons—OSA and turbinate hypertrophy.

Answer:

Although CPT® 42975 and turbinate procedures (30801/30802) address distinct clinical conditions such as dynamic airway collapse in OSA versus nasal obstruction from turbinate hypertrophy, they are bundled under National Correct Coding Initiative (NCCI) edits due to shared anatomical access and procedural overlap.

Additionally, CMS coding policy states that when a diagnostic procedure leads directly to a therapeutic intervention during the same operative session, only the therapeutic procedure should be reported. The diagnostic service is considered part of the decision-making process and is not separately reimbursable.

According to CMS and NCCI guidelines, CPT® codes 30801 and 30802 cannot be separately reported when performed in the same session as other nasal or sinus procedures, including:

• For access to the nose or sinuses

• For control of intraoperative bleeding

• When performed concurrently with other nasal procedures

Importantly, modifiers such as 59 or XU are not permitted to bypass this bundling, even if the procedures are performed for separate indications. It is important to remember that turbinate hypertrophy can contribute to sleep-disordered breathing, including OSA. The coding system treats these procedures as components of a single encounter when performed together, and separate reimbursement is not allowed.

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

Reporting 36015

Question:

We have seen some illustrations suggesting the maximum number for reporting 36015 in one session is 5 (3-right(U,M,L), 2 Left(U,L). This method only counts the lobar arteries and excludes counting the segmental arteries. Is it your opinion that each segmental artery can be individually reported? For example, if the provider performed selective catheterization on the right side of the medial basal segment, the posterior basal segment and the lateral basal segment would this count as three (3) total under the lower lobe or count as one (1) since all are in the lower lobe?

Answer:

You can bill 36015 for each distinct selective catheterization, but only when those vessels are legitimately separate branches per the CPT Appendix L vascular-family hierarchy.

Segmental or subsegmental arteries within the same lobar distribution are not separately reportable; they are included in a single unit of 36015 for that lobe. Therefore, selective catheterization of the medial basal, posterior basal, and lateral basal segmental branches would count as one (1) selective catheterization under the right lower-lobe pulmonary artery, not three.

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

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.