Reporting Rhinoplasty with Septal Repair

Question:

Our physician frequently performs septorhinoplasty procedures to address severe septal deviation and, in some cases, nasal valve collapse. He typically bills CPT 30420, which includes major septal repair. However, we are seeking clarification due to conflicting references: the Coders’ Desk Reference describes 30420 as involving nasal bone fracture and repositioning, and other sources suggest it is primarily a cosmetic procedure. Given that our physician’s intent is functional, improving airway obstruction, does CPT 30420 still apply? Is reshaping of the nasal tip or dorsal hump required to justify 30420, or would CPT 30520 (septoplasty) be more appropriate in these cases?

Answer:

The Coders’ Desk Reference includes an introductory disclaimer stating that each procedural description represents one possible method of performing the service and should not be interpreted as the only acceptable approach. Its narrative examples are intended to illustrate common surgical techniques, not to define the required components of the CPT code itself. If both a rhinoplasty and septoplasty are performed, report 30420 to capture the combined procedure, as this code includes major septal repair. Ensure that the appropriate functional or reconstructive diagnosis is reported on the claim to support medical necessity.

*This response is based on the best information available as of 02/05/26.

Biceps Tenodesis or Tendon Transfer

Question:

The provider performs shoulder arthroplasties and also does a bicep muscle transfer to the pectoralis muscle. He bills 23472 for the arthroplasty and then wants to bill 23395 for the muscle transfer. The portion of his note for this procedure is: "I then traced the long head of the biceps brachii from the pectoralis major through the rotator interval and released the biceps from its origin. The biceps tendon was diseased from the groove to its insertion on the supraglenoid tubercle. I then sutured the tendon into the pectoralis major tendon as a muscle transfer." I am not in agreement that this procedure is representative of 23395 and think it should be 23430, which would bundle with the shoulder arthroplasty. Do you have any guidance on the correct use of 23395 and if it is the correct code in this situation? Thank you.

Answer:

Thank you for your question. We have noticed providers trying to bill for 23472 and 23395 vs. 23472 and 23430.  Attaching the biceps tendon to the pectoralis major in the scenario you provided above should be coded to 23430. Reattaching the biceps, regardless of the location it is reattached, is considered a biceps tenodesis and should not be confused with a tendon transfer. 

There is an NCCI edit between 23472 and 23430 which needs to be followed for government payors. CPT Assistant July 2024 as well as the American Academy of Orthopaedic Surgeons' Global Service Data (GSD) both state the biceps tenodesis is not part of the shoulder arthroplasty. A separate diagnosis for the biceps pathology should be added and linked to CPT 23430.

*This response is based on the best information available as of 02/05/26.

Diagnosis Coding for Renal Angiography

Question:

What would be the appropriate ICD-10-CM code if the patient comes for renal artery bleeding and the physician studies renal angiogram and found no active extravasation? Diagnosis R58 is not payable diagnosis as per LCD policy for CPT 36253.  Can  you provide some guidance?

Answer:

When renal angiography is performed for suspected renal artery bleeding and no active extravasation is identified, the diagnosis must accurately reflect the clinical indication and intent of the study. Because nonspecific symptom codes such as diagnosis code R58 do not define an anatomical site or etiology, they often do not support the medical necessity of the procedure.

The order and final impression should clearly document the suspected or underlying cause prompting the angiogram (for example, postprocedural hemorrhage or renal injury). If documentation is unclear or a specific diagnosis cannot be identified, it is appropriate to query the provider to determine the most accurate diagnosis supporting medical necessity. When no suitable ICD-10 code can be established after clarification, append the appropriate G modifier based on ABN status to indicate that medical necessity may not be supported for the service.

*This response is based on the best information available as of 02/05/26.

Repair of Pyloric Channel Ulcer with Graham Patch

Question:

Hello, we are reporting repair of pyloric channel ulcer with 43840 and the omental flap with 49905, we keep getting feedback from an external auditor that 49905 is not separately reportable. Could you please clarify how this procedure should be reported and the reasoning?

Answer:

Code +49905 is not reported separately when used to secure a suture line in an ulcer repair as you described, or for securing an anastomosis in colon resection as another example.

CPT code +49905, omental flap, intraabdominal, is intended for an omental flap to reconstruct a defect, for example after lesion resection, to fill an anatomic defect resulting from that resection.

*This response is based on the best information available as of 02/05/26.

Reporting an E/M Service on the Same Date as Mohs Surgery

Question:

I code for 2 Mohs surgeons and I am confused about whether or not we can code for an E/M service on the same day as Mohs. Here is the situation: The patient is referred by an outside Dermatologist and scheduled for Mohs surgery with one of our Mohs surgeons. The patient brings in a biopsy that was performed the previous week. Can we bill a new patient E/M visit since the physician has to evaluate the patient before performing Mohs?

Answer:

If the patient has been scheduled for Mohs surgery and the evaluation performed is the routine preoperative assessment necessary to perform the procedure, do not bill the E/M service. The E/M service is inherent to Mohs surgery. The E/M service is only billable if it goes beyond the inherent preoperative work, meaning it must be significant and separately identifiable and well documented in the medical record.

*This response is based on the best information available as of 01/22/26.

Coding Clarification: Instrumentation Removal vs. Exploration Based on Intent

Question:

Good afternoon,

I recently came across one of your Q&As from June 2025 that stated when spinal instrumentation is removed for the purpose of exploration, we would code the exploration CPT code 22830. This is helpful information; however, I am wondering if you can provide a reference for this. I would love to pass this information along to our providers, and a solid source would help to support it.

Answer:

In June 2025, the coding question was clarified:

CPT code 22830 should be billed if the intent for the procedure was for exploration.

If the intent is to explore the spinal fusion site, and instrumentation is removed only to allow that exploration, then CPT 22830 is reported. If the true intent is to remove the instrumentation (e.g., due to pain, infection, or hardware failure), and exploration is incidental, then only the instrumentation removal code is reported.

The National Correct Coding Initiative (NCCI) bundles certain codes based on the principle of standards of medical/surgical practice, which means: If a service is routinely performed as part of another procedure, it is considered integral and not separately reportable.

*This response is based on the best information available as of 01/22/26.