Diagnostic Ultrasound Followed by Ultrasound Guided Injection

Question:

We have a Pain Interventionalist performing diagnostic MSK ultrasounds, followed by an ultrasound guided injection. We bill both codes but the claims keep bundling. Is there a way to avoid this?

Answer:

Thank you so much for reaching out with your question. Based on your question, KZA is happy to share the general guidelines for Ultrasound billing with you. An ultrasound-guided injection, for example CPT 20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting, involves a focused ultrasound assessment. This includes capturing, labeling, and interpreting images from different angles around the affected area. The goal is to find the best approach for the injection, while noting normal anatomy and any signs of issues. Imaging helps guide the needle safely into the joint or bursa, avoiding bones, blood vessels, and other sensitive structures. Afterward, the findings are carefully documented in the patient’s chart to keep everyone informed. If a diagnostic ultrasound is performed at the same location, it’s included as part of the ultrasound-guided procedure.  

If a diagnostic ultrasound is performed at the separate anatomic location, a modifier 59 or X{ESPU} modifier may be appropriate. Please know that this will be under high scrutiny with the payors. 

KZA has free KZA KAST podcasts on both modifier 59 and the subset X {ESPU} for additional information on the appropriate application of these modifiers. 

Modifier 59 - Part 1

https://monday.transistor.fm/episodes/modifier-59-part-1

Subset Modifier XE

https://monday.transistor.fm/episodes/subset-modifier-xe

*This response is based on the best information available as of 07/09/26.

Breast Reduction with Lipo

Question:

I am looking for KZA’s recommendation. If both a breast reduction (19318), and a suction-assisted lipectomy (15877) is also performed can both procedures be reported?

Answer:

Suction-assisted lipectomy performed to enhance the outcome of a breast reduction is considered part of the primary procedure and is not separately reportable. Additionally, according to NCCI edits, code 15877 is bundled with 19318. Therefore, if the documentation supports both open excision of breast tissue for reduction and suction-assisted lipectomy, it would be appropriate to report only 19318.

Thank you for reaching out to KZA with your inquiry.

*This response is based on the best information available as of 07/09/26.

22842 vs. 22843?

Question:

Would this be reported as 22842 or 22843? The documentation supports placing screws at C2, C3, C4, C5, C7, and T1 – with no screws at C6.

Answer:

Great question. Posterior segmental instrumentation is reported based on the number of attachments and the segments spanned. In the scenario presented above, the documentation supports more than two points of attachment, and the instrumentation spans 7 segments, even with C6 screws skipped. Therefore, code 22843 would be appropriate.

Thank you for reaching out to KZA

*This response is based on the best information available as of 07/09/26.

Are Superior Labrum Tears coded to CPT 29806 or 29807?

Question:

Would 29807 or 29806 be reported for a repair of the superior anterior labrum without posterior extension? There is some confusion regarding the term "Superior" as being a qualifying factor pointing towards 29807 vs. 29806. Does the location of the tear being "Superior" qualify the tear to be reported with 29807 vs. 29806 regardless of whether both the anterior and posterior portions of the superior labrum were torn and repaired? The snippet of the operative report in question below documents only the anterior portion of the superior labrum was torn and repaired.

• "Diagnostic arthroscopy was performed. A tear of the anterior superior labrum was confirmed on diagnostic arthroscopy. The remainder of the labrum was intact. Attention was then turned to the repair of the anterior superior labrum and the labral cyst. The anterior superior glenoid was first debrided and the margin of the glenoid was debrided with the use of shave. Once bony bleeding had been achieved, attention was turned to placing the suture anchors. A total of two anchors were placed in a mattress stitch configuration, positioned anterior‑superiorly and superiorly.”

Answer:

I find that reviewing the labrum as a clock helps determine the best coding. To avoid confusion, as you present here, operative note dictation describing where the anatomic location of the tear is also beneficial.

With that said, the term "superior" is not necessarily the qualifying factor for selecting either CPT 29807 vs. 29806. As if you are looking at a clock, the SLAP tear occurs between the 11 (posterior) and 1 (anterior) positions. The anterior superior labrum is between the 1 and 3 position, therefore it is likely that a tear in the anterior superior labrum can be coded to 29807.

*This response is based on the best information available as of 06/04/26.

eTEP Hernia Repairs

Question:

Our provider is doing hernia repairs with an eTEP which was explained to me as a myofascial advancement. Is this separately billable or is it considered bundled to the hernia repair?

Answer:

eTEP (extended or enhanced view totally extraperitoneal) describes the surgical approach utilized for the procedure. The coding for anterior abdominal hernia repair remains the same regardless of the approach performed. The appropriate repair code should be selected based on whether the hernia is initial or recurrent, as well as the total defect size.

*This response is based on the best information available as of 06/04/26.

SI Joint Injection in an ASC Coding

Question:

Does Medicare require a different code than 27096 for SI joint injections billed to an ASC?

Answer:

Yes. For ASC (Ambulatory Surgery Center) billing, Medicare requires HCPCS code G0260 for facility billing instead of 27096. For professional (physician) billing, use 27096. Remember to always verify payor-specific requirements.

*This response is based on the best information available as of 06/04/26.