I&D of Spinal Abscess

Question:

We are seeing cases where, after an initial I&D for a spinal abscess (coded 22010–22015), patients require additional trips to the OR to clear residual infection and promote healing. For these subsequent surgeries, could you clarify whether it is appropriate to reuse 22010–22015 for repeat I&Ds?

Answer:

Great question. Code selection depends on documentation. Codes 22010–22015 are specific to deep (subfascial) posterior spine abscesses, as defined by the code descriptor.

If the documentation supports an open incision and drainage of a deep (subfascial) posterior spine abscess, it would be appropriate to report it, regardless of the timing of surgery.

It should be noted that there are parenthetical instructions that should be reviewed, as they provide additional information and guidance.

*This response is based on the best information available as of 08/13/26.

Bilateral Straightforward: Angioplasty

Question:

What CPT codes would you use for bilateral straightforward angioplasty of the right and left external iliac arteries using one access site? Can you use 37254-50 or would it be 37254 for the initial vessel and 37255 for the vessel on the contralateral side?

Answer:

For bilateral straightforward angioplasty of the external iliac arteries (EIA) performed via a single access site, the correct coding approach in 2026 is to use the initial vessel code for each side, rather than using the "additional vessel" add-on code for the contralateral iliac artery.

Under current CPT guidelines for lower extremity revascularization procedures are reported based on anatomical vascular territories (Iliac, Femoral/Popliteal, Tibial/Peroneal, and Inframalleolar) and are typically unilateral.

The appropriate code for a "straightforward" angioplasty in the iliac territory is 37254 (initial vessel) and 37255 (each additional ipsilateral vessel). Because you are treating two different anatomical sides (Right and Left), both are considered "initial" vessels for their respective territories.

Primary Code: 37254 (Iliac territory angioplasty, straightforward, initial vessel)

Append Modifier 50 to the primary code (37254-50) or report as 37254-RT and 37254-LT, depending on payer preference.

*This response is based on the best information available as of 08/13/26.

Arthroscopic Biceps Tenotomy

Question:

We are having a debate in our practice on the proper CPT code for an arthroscopic biceps tenotomy.  We have seen some sources state that an arthroscopic bicep tenotomy is considered a debridement and billed under 29822/29823. Others reference CPT 29999 as it seems more like a release and not a debridement. Is there a clear answer on why an arthroscopic bicep tenotomy is considered a debridement and is it correct to be billing 29822 versus 29999?

Answer:

Thank you for your question, coding for an arthroscopic biceps tenotomy has been disputed for many years.  CPT Assistant January 2018 confirms that an arthroscopic biceps tenotomy is coded to the arthroscopic debridement codes, 29822/29823, depending upon how many other distinct structures are debrided. 

Remember if an arthroscopic biceps tenotomy is performed during the same operative session as an arthroscopic or open biceps tenodesis, only the biceps tenodesis would be coded. 

*This response is based on the best information available as of 08/06/26.

17110 for AK?

Question:

Is 17110 appropriate for using liquid nitrogen for irritated actinic keratoses?

Answer:

No — 17110 is not the correct destruction code for actinic keratoses.

Destruction of actinic keratoses should be reported as follows:

• 17000 for the first lesion

• 17003 for each additional lesion (for lesions 2–14)

• 17004 when 15 or more lesions are treated

Documentation should clearly include the method of destruction, the location of each lesion, and the total number treated.

Thank you for reaching out to KZA!

*This response is based on the best information available as of 08/06/26.

Instrumentation for CPT 69210

Question:

For CPT 69210, is suction, by itself, considered instrumentation for this procedure code?

Answer:

According to the AAO-HNS, using CPT code 69210 is reported based on what instruments are used to remove the impacted ear wax.  Instrumentation is defined as the use of an otoscope and instruments such as wax curettes, wire, loops or suction specific ear instruments (e.g., cup loops, right angle hook) or a similar tool designed for controlled wax extraction. Documentation should indicate the equipment used to provide the service.  

*This response is based on the best information available as of 07/16/26.

Pilonidal Disease Excision

Question:

I frequently perform adjacent tissue transfers (CPT 14000, 14001, 14020). When I excise pilonidal disease (CPT 11770, 11771, 11772) and then perform an adjacent tissue transfer, can I report both the excision and the tissue transfer codes, or is only the tissue transfer separately billable?

Additionally, in cases where I excise a malignant lesion (CPT 11604, 11606) and close the defect with an adjacent tissue transfer, my understanding is that only the adjacent tissue transfer code (e.g., 14000) is reportable, and the excision is considered included. Is this correct?

Answer:

This is a great question. Even though pilonidal excision is a “disease excision” rather than a lesion excision, CPT still treats the excision as included in the ATT. If you excise pilonidal disease and close with an adjacent tissue transfer (e.g., Limberg flap, Karydakis flap, Z-plasty), you bill only the ATT code (14000–14001–14020 etc.). Keep in mind when you perform an adjacent tissue transfer to close a defect, you do NOT separately bill the excision of a lesion (benign or malignant).

The ATT includes:

• Creating the defect (whether by trauma or excision)

• Preparing the wound bed

• Closing the defect with the flap

The excision is considered included in the ATT code.

This applies to:

• Benign lesion excision (11400 series)

• Malignant lesion excision (11600 series)

• Benign cyst excision (e.g., pilonidal disease 11770–11772)

• Scar revision excision

• Any excision that results in the defect you are closing with ATT

*This response is based on the best information available as of 07/16/26.