Interspinous Ligament Injection

Question:

Our doctor performed an interspinous ligament injection L3-4 for the diagnosis of lumbar interspinous bursitis. I billed CPT 20550 but was unable to code the anatomical modifier LT or RT because it was injected directly into the ligament. Would CPT code 22899 be more appropriate, as 20550 requires an anatomical modifier?

Answer:

If an interspinous ligament injection is performed due to bursitis, the correct CPT code would be 20550. Unlisted CPT codes are utilized when a specific CPT code does not exist.

A specific CPT code exists for this procedure therefore, 20550 is used. 

*This response is based on the best information available as of 04/02/26.

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 04/02/26.

Mod 62 & Spinal Instrumentation

Question:

Our coding department has a question. Due to the high complexity of the case, two surgeons from different specialties (an orthopedic surgeon and a neurosurgeon) completed the surgery together. Can modifier 62 be applied to spinal instrumentation codes?

Answer:

Although two surgeons from different specialties were involved in this complex case, modifier 62 cannot be appended to spinal instrumentation codes.

CPT guidelines specifically state: “Do not append modifier 62 to spinal instrumentation codes (22840–22848, 22850, 22852, 22853, 22854, 22859).”

Modifier 62 (Two Surgeons) applies only when each surgeon performs distinct, separate portions of the same procedure, and each surgeon must document their specific portion in separate operative reports.  

Example: For an ALIF, if a general or vascular surgeon performs the approach and closure, while a spine surgeon performs the interbody procedure…

• Both surgeons would document their respective portions of the operative service.

• Both would report CPT 22558‑62.

• This meets CPT criteria for true co‑surgery. 

If the second surgeon is participating specifically in the placement of spinal instrumentation, consideration should be given to whether an assistant‑at‑surgery modifier (80 or 82) may be appropriate, since modifier 62 is not allowed on instrumentation codes.

*This response is based on the best information available as of 04/02/26.

Removing a Nasal Pack

Question:

I have looked everywhere and cannot find a CPT code for removing a posterior nasal pack. I found CPT code 30906 for reporting control of a nasal hemorrhage when removing and replacing the pack. Can I report 30906 with Modifier 52 since my doctor is just removing the posterior nasal pack?

Answer:

No, you do not report 30906. There is not a code for removing a posterior pack unless you are replacing the pack at the same time. If you are only removing a pack then report an E/M CPT code or nasal endoscopy code (31231) whichever is more appropriate.

*This response is based on the best information available as of 04/02/26.

Tibial Plateau Fractures

Question:

Can you please clarify if CPT 27536 requires two incisions, one for the medial and one for the lateral to be able to use this code?

Answer:

While the common approach to a bicondylar tibial plateau fracture is by two incisions, one medial and one lateral, it is not required. The bicondylar fracture can be treated by a single midline approach for dual plating. 

What is important is that a bicondylar tibial fracture is being treated.  

CPT description reads: CPT 27536 Open treatment of tibial fracture, proximal (plateau); bicondylar, with or without internal fixation.

*This response is based on the best information available as of 04/02/26.

Transcarotid TAVR: Unlisted Code 33799

Question:

My hospital wants to pursue elective TAVR via carotid approach. Normally via percutaneous femoral approach, the Interventional Cardiologist and Cardiac Surgeon bill for the case. If they request me for open carotid artery exposure (as Vascular Surgeon), is there a way for me to bill as a third provider?

Answer:

There is currently no specific CPT code for transcarotid TAVR, so the entire procedure is reported using unlisted cardiac surgery code 33799. When submitting 33799, it is best practice to include a crosswalk to the comparable TAVR code range 33361–33366 to support valuation and reimbursement. Because all TAVR/TAVI codes include vascular access, exposure, and closure as bundled components, separately billing for access (e.g., carotid cutdown or repair) would not be appropriate. TAVR procedures are intended to be performed by two co-surgeons—a cardiothoracic surgeon and an interventional cardiologist, who each report the procedure using modifier 62 (co-surgery). If a vascular surgeon participates in the case for carotid exposure, the only potential billing pathway would be to attempt team-surgery reporting (modifier 66). However, this is not always accepted and would require that the payer recognizes the team-surgery model and that documentation supports the medical necessity of both the carotid approach and the involvement of all participating surgeons. Because the carotid approach remains an unlisted service, obtaining payer preauthorization or a pre-determination of coverage is strongly recommended to confirm acceptance of both the unlisted code (33799) and the team-surgery structure before scheduling an elective case.

*This response is based on the best information available as of 04/02/26.