Lidocaine and/or Bupivacaine

Question:

When billing corticosteroid injection in office, can you bill out lidocaine and/or bupivacaine separately or are they bundled within the injection?

Answer:

Lidocaine and/or bupivacaine are not separately billable when used with a corticosteroid injection in the office. CPT states that local infiltration of anesthesia is included in the global surgical package. CMS states that any anesthesia provided by the operating surgeon is also included. 

*This response is based on the best information available as of 05/07/26.

CPT Code 42842 vs. 42844

Question:

I have a question. Which CPT code would I use? If local tissue rotational flaps isn’t done, would we report CPT 42842 or CPT 42844? Is it appropriate to bill CPT 42844 if local tissue rotational flaps aren't performed? Per documentation. "We then commenced with primary closure of the defect with 3-0 Vicryl in a horizontal mattress fashion."

Answer:

Thank you for your great question. CPT code 42844 would not be appropriate code based on the documentation as written. Your note states: "primary closure of the defect with 3-0 Vicryl in a horizontal mattress fashion." This describes a primary/direct closure (approximating wound edges with sutures), not a local tissue rotational flap. These are fundamentally different techniques:

• Primary closure = suturing wound edges together

• Local tissue flap = mobilizing and rotating/advancing adjacent tissue to cover a defect (e.g., rotation flap, advancement flap, transposition flap)

A local tissue flap requires distinct documentation of flap design, elevation, rotation/advancement, and inset — none of which are described here. Based on the documentation the correct code to report is 42842.

*This response is based on the best information available as of 05/07/26.

ALIF via Retroperitoneal Approach

Question:

I have been researching the coding for ALIF via retroperitoneal approach, and my research points to 22558 or an unlisted spine code; however, my provider states it should be CPT 22533. Can you please help?

Answer:

Thank you for your question!

CPT 22533, as suggested by your provider, refers to a lateral extracavitary arthrodesis (LECA), which is an anterior fusion performed from a posterior approach.

A CPT Assistant from October 2009 discusses the lateral extracavitary (LECA) approaches to the lumbar spine and explains how to differentiate LECA from other approaches.

For an anterior lumbar interbody fusion (ALIF) performed via a retroperitoneal approach, the correct CPT code is 22558.

*This response is based on the best information available as of 05/07/26.

19432? Removal and Reinsertion of Implant

Question:

My surgeon wants to report 19342 when a patient develops a seroma post‑reconstruction. The implant is removed, the seroma is drained, and the same implant is reinserted. Is this appropriate?

Answer:

Great question! The Breast Repair and/or Reconstruction subsection guidelines provide specific direction regarding the use of code 19342.

According to the guidelines:
“In delayed reconstruction, an implant is placed at any date separate from the mastectomy (19342). This includes placement of any new implant or replacement of an existing implant within the mastectomy defect or reconstructed breast.”

In the scenario described, the implant is temporarily removed to allow drainage of the seroma and then reinserted. Because the same implant is returned to the pocket—and no new or replacement implant is placed—19342 would not be appropriate under the guidelines.

Thank you for reaching out to KZA!

*This response is based on the best information available as of 05/07/26.

Exploratory Laparotomy with Other Procedures

Question:

Can we code for an exploratory laparotomy if we then perform another procedure that we did not know was necessary prior to the laparotomy?

Answer:

No, exploratory laparotomy is always included in other definitive procedures.

*This response is based on the best information available as of 04/07/26.

1500X Surgical Prep & 14XXX ATT Codes

Question:

Is it appropriate to bill surgical preparation codes (1500X) with adjacent tissue transfer codes (14XXX)?

Answer:

Yes. Surgical preparation codes may be reported with adjacent tissue transfer (ATT) codes when the documentation supports that a separate and medically necessary wound‑bed preparation service was performed.

The Skin Replacement Surgery subsection guidelines state that “Surgical preparation codes 15002–15005 for skin replacement surgery describe the initial services required to prepare a clean and viable wound surface for placement of an autograft, flap, skin substitute graft, or for negative pressure wound therapy.”

Since the definition specifically includes flap and adjacent tissue transfer, which is classified as a flap procedure, the combination is appropriate when both services are distinctly documented and not considered inherent to the ATT itself.

Thank you for reaching out to KZA!

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