An inferior dermal flap may be reported using the Adjacent Tissue Transfer (ATT) code set (CPT 14xxx), provided the documentation supports. According to CPT Assistant guidance, the adjacent tissue transfer codes should be used for a de-epithelialized autoderm flap, based solely on the transposed area.

However, according to Medicare’s National Correct Coding Initiative (NCCI) Policy Manual, adjacent tissue transfer or rearrangement is considered included in breast reconstruction procedures when performed as part of those services.

Excerpt from the NCCI Manual:

“Breast reconstruction procedures (CPT codes 19357–19369) include adjacent tissue transfer or rearrangement procedures (e.g., CPT codes 14000, 14001) if performed. An adjacent tissue transfer or rearrangement procedure may be reported on the same day as a breast reconstruction procedure only if it is performed at a different site unrelated to the breast reconstruction.”

Key Point: According to Medicare guidelines, ATT codes are not separately reportable when performed as part of breast reconstruction, as outlined in the NCCI Manual, Chapter III. If you apply these guidelines universally to all payors, the ATT code would not be reported.

*This response is based on the best information available as of 08/20/26.

William Via 8/20/26 William Via 8/20/26

Incarcerated Appendix Removed During Inguinal Hernia Repair

I have a pt who came for repair of incarcerated inguinal hernia. The approach was laparoscopic. Aright inguinal hernia was identified. It was found to be containing incarcerated appendix. Attempts to reduce the appendix were unsuccessful with shearing of the serosa. Using scissors with cautery the peritoneum was opened from the right anterior superior iliac spine to the median umbilical ligament. The contents were dissected off the inferior flap laterally and down to the pubic tubercle medially. The round ligament was dissected off the hernia sac and the hernia sac was reduced into the abdominal cavity. The appendix was densely scarred in and dissection around the appendix was done until the hernia sac was completely cleared but the appendix did break apart. So would I code the incarcerated inguinal hernia only or how would I capture the appendectomy?

Question:

I have a patient who came for repair of incarcerated inguinal hernia. The approach was laparoscopic. A right inguinal hernia was identified. It was found to be containing incarcerated appendix. Attempts to reduce the appendix were unsuccessful with shearing of the serosa. Using scissors with cautery, the peritoneum was opened from the right anterior superior iliac spine to the median umbilical ligament. The contents were dissected off the inferior flap laterally and down to the pubic tubercle medially. The round ligament was dissected off the hernia sac, and the hernia sac was reduced into the abdominal cavity. The appendix was densely scarred in and dissection around the appendix was done until the hernia sac was completely cleared but the appendix did break apart. So, would I code the incarcerated inguinal hernia only or how would I capture the appendectomy?

Answer:

Per CPT, excision and/or repair of strangulated organs or structures are reported in addition to the repair of the strangulated hernia. However, if the appendectomy was performed due to an iatrogenic injury, the treatment of an iatrogenic complication is not separately reportable. Be sure that your documentation is clear in making the distinction between the two scenarios.

*This response is based on the best information available as of 08/20/26.

William Via 8/13/26 William Via 8/13/26

I&D of Spinal Abscess

We’re seeing cases where, after initial I&D for spinal abscess (coded 22010–22015), patients require additional procedures to clear residual infection and promote healing. For these follow-ups, we’ve used debridement codes (11042–11047) and exploration of spinal fusion code 22830 when applicable.

Some providers feel 22010–22015 may still apply since the infection persists. Could you clarify, is it appropriate to reuse 22010–22015 for repeat I&Ds?

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.

William Via 8/13/26 William Via 8/13/26

Bilateral Straightforward: Angioplasty

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

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.

William Via 8/5/26 William Via 8/5/26

Arthroscopic Biceps Tenotomy

Hi 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. Other's 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?

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.