Multiple Femoral Fractures

Question:

I am wondering about charging both CPT codes 27506 (femur shaft) and 27245 (femur intertrochanteric). There is an NCCI edit indicating that 27245 is included with 27506 per mutually exclusive procedures. The provider is saying these are two separate injuries/entities and we should use a modifier. However, I am not sure if that would be correct since they are both on the same bone, just different locations of it. Can you please explain if it would be appropriate to code both codes for the same femur? It seems they are using one nail to fix both fractures. What if they are two separate fractures, does that make a difference? I am having trouble locating any guidance for this scenario. Thank you for your insight.

Answer:

If one intramedullary implant is being placed to treat an intertrochanteric, peritrochanteric, or subtrochanteric fracture in addition to a femoral shaft fracture, only one code would be used. There is an NCCI edit stating that they are mutually exclusive procedures, and a modifier would not be appropriate to override the edit. 

Modifier 22 Increased Procedural Services may be appended if the documentation supports that the work required to treat the fractures was substantially greater than typically required. 

Code selection of either 27506 or 27245 should be determined by the provider based on which treatment was more extensive. 

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

Lipoma Question

Question:

If a surgeon excises a subcutaneous lipoma in the thigh and inadvertently violates the fascia, would the repair level be above the fascia or within the fascia for coding purposes?

Answer:

Great question. In this scenario, there would be no separate reporting for the repair. Excision of a subcutaneous lipoma of the thigh is coded using a procedure code from the 2xxxx series, and closure—whether above or at the fascia—is considered inherent to the excision and is not separately reported.

Thank you for reaching out to KZA!

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

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.