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E/M Leveling on a Recurrent Keloid
The patient has a recurrent keloid following surgical excision and is largely asymptomatic, with only occasional pruritus and burning. Does this fall under low or moderate medical decision making.
Question:
The patient has a recurrent keloid following surgical excision and is largely asymptomatic, with only occasional pruritus and burning. Does this fall under low or moderate medical decision making?
Answer:
Based on the condition alone, a recurrent keloid that is stable and only mildly symptomatic would generally meet Low MDM under the “Number and Complexity of Problems Addressed” element. However, the final MDM level cannot be determined without considering the other two MDM elements: data reviewed and the risk of treatment and management. If no data is reviewed and management is limited to observation, conservative measures, or a minor procedure with no risks the overall MDM would remain Low.
*This response is based on the best information available as of 03/05/26.
Nerve Transection CPT 64772
How do I code an AIN and/or PIN Neurectomy?
Question:
How do I code an AIN and/or PIN Neurectomy?
Answer:
You're question is excellent timing. CPT code 64772 Transection or avulsion of other spinal nerve, extradural is used for an AIN and/or PIN Neurectomy. In January 2026, CMS increased the MUE (medically unlikely edit) for 64772 from 2 units to 6 units.
*This response is based on the best information available as of 03/05/26.
Coding 61750 vs. 61751 for a Stereotactic Biopsy
We struggle with the code description for CPT 61750 vs 61751. Our providers load MRI and/or CT scans to a stereotactic navigation machine during surgery for Stereotactic biopsy, aspiration, or excision of a tumor. Which code would be correct when an MRI scan is used during surgery? The scan was done prior to going to the OR.
Question:
We struggle with the code description for CPT 61750 vs 61751. Our providers load MRI and/or CT scans to a stereotactic navigation machine during surgery for Stereotactic biopsy, aspiration, or excision of a tumor. Which code would be correct when an MRI scan is used during surgery? The scan was done prior to going to the OR.
Answer:
Code 61751 is reported regardless of when the CT was performed, and it is typically performed before the patient goes to the OR.
*This response is based on the best information available as of 02/07/26.
Coding a Flap after Mohs Surgery
A patient was seen by a dermatologist in their clinic for a MOHS procedure. After completion of MOHS, the patient went to the ambulatory surgical center for our ENT provider to perform CPT 14060. Since the ENT did not perform the MOHS excision but did perform the flap, would a 52 modifier have been appropriate since the opening excision was performed by a different specialty at a different location?
Question:
A patient was seen by a dermatologist in their clinic for a MOHS procedure. After completion of MOHS, the patient went to the ambulatory surgical center for our ENT provider to perform CPT 14060. Since the ENT did not perform the MOHS excision but did perform the flap, would a 52 modifier have been appropriate since the opening excision was performed by a different specialty at a different location?
Answer:
Thank you for your question. Modifier 52 (Reduced Services) is only used when the same provider performs a service but reduces or does not complete the full work of the CPT code.
In this case your ENT did perform the full flap procedure described by CPT 14060. The fact that a different specialty performed the Mohs excision beforehand does not mean your ENT performed a reduced service. The ENT was not expected to perform the excision because the Mohs surgeon already did it. The flap reconstruction can be billed by ENT without a modifier.
*This response is based on the best information available as of 02/05/26.
CMC Joint Injections
My hospital coder recently told me that I should not bill CMC injections as 20605 but rather 20600. I remember during the conference that 20605 is a justifiable code for thumb CMC joint injections. Can you verify that this is correct and offer me some guidance on what to present to the hospital coder?
Question:
My hospital coder recently told me that I should not bill CMC injections as 20605 but rather 20600. I remember during the conference that 20605 is a justifiable code for thumb CMC joint injections. Can you verify that this is correct and offer me some guidance on what to present to the hospital coder?
Answer:
Thank you for your question. The current guidance, based on an AMA CPT Assistant from August of 2017, is an injection into the CMC joint is 20600.
*This response is based on the best information available as of 02/05/26.
Denial - 19371
We received a denial for 19371 when billed with 19342 for an implant exchange to a smaller implant. Is the denial correct?
Question:
We received a denial for 19371 when billed with 19342 for an implant exchange to a smaller implant. Is the denial correct?
Answer:
This is a great question and a common scenario.
While coding guidance indicates that code 19371 may be reported in addition to code 19342, this is considered correct coding under CPT rules.
However, Medicare’s National Correct Coding Initiative (NCCI) bundles 19371 into 19342. Additionally, modifier 59 should not be appended to 19371 to bypass the NCCI edit when both procedures are performed on the same breast. The denial is correct when billing Medicare or payers that follow NCCI edits.
Thank you for reaching out to KZA with your inquiry!
*This response is based on the best information available as of 02/05/26.
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