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 codes15002–15005 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.

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

Inflammatory Polyps in Ulcerative Colitis

Question:

Patient had a colonoscopy with biopsy of a polyp. The path came back as inflammatory polyp. Can ICD-10 K51.40 be used for this? I am being told it cannot unless the patient has ulcerative colitis since the code falls under K51.

Answer:

Thank you for your question. No you cannot use K51.40 (inflammatory polyps in ulcerative colitis, unspecified) for an inflammatory polyp unless the patient has documented ulcerative colitis. Every code under K51.- belongs to the ICD‑10‑CM chapter for Ulcerative Colitis.  Ulcerative colitis must be documented to report any code in category K51.

Correct coding for an inflammatory polyp when ulcerative colitis is NOT present:

1. Benign neoplasm of colon (if clinically considered neoplastic). D12.6 — Benign neoplasm of colon, unspecified-or a more specific code based on location (e.g., D12.2 for ascending colon). This is commonly used when a polyp is not malignant and does not fall into a more specific category.

2. Polyp of colon-K63.5 (if pathology does not support neoplasm). This is often appropriate when pathology identifies a non‑neoplastic, inflammatory polyp. Most inflammatory polyps—particularly those unrelated to ulcerative colitis—are coded to K63.5 (Polyp of colon).

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

Interspinous Ligament Injection

Question:

Our doctor performed an interspinous Ligament injection L3-4 for the diagnosis of lumbar interspinous bursitis. I billed CPT 20550 but was unable to code the anatomical modifier LT or RT because it was injected directly into the ligament. Would CPT code 22899 be more appropriate, as 20550 requires an anatomical modifier?

Answer:

If an interspinous ligament injection is performed due to bursitis, the correct CPT code would be 20550. Unlisted CPT codes are utilized when a specific CPT code does not exist.

A specific CPT code exists for this procedure therefore, 20550 is used. 

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

Medical Decision Making

Question:

The patient has a recurrent keloid following surgical excision and is largely asymptomatic, with only occasional pruritus and burning. Does this fall under low or moderate medical decision making?

Answer:

Based on the condition alone, a recurrent keloid that is stable and only mildly symptomatic would generally meet Low MDM under the “Number and Complexity of Problems Addressed” element. However, the final MDM level cannot be determined without considering the other two MDM elements: data reviewed and the risk of treatment and management. If no data is reviewed and management is limited to observation, conservative measures, or a minor procedure with no risks the overall MDM would remain low.

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

Mod 62 & Spinal Instrumentation

Question:

Our coding department has a question. Due to the high complexity of the case, two surgeons from different specialties (an orthopedic surgeon and a neurosurgeon) completed the surgery together. Can modifier 62 be applied to spinal instrumentation codes?

Answer:

Although two surgeons from different specialties were involved in this complex case, modifier 62 cannot be appended to spinal instrumentation codes.

CPT guidelines specifically state: “Do not append modifier 62 to spinal instrumentation codes (22840–22848, 22850, 22852, 22853, 22854, 22859).”

Modifier 62 (Two Surgeons) applies only when each surgeon performs distinct, separate portions of the same procedure, and each surgeon must document their specific portion in separate operative reports.  

Example: For an ALIF, if a general or vascular surgeon performs the approach and closure, while a spine surgeon performs the interbody procedure.

• Both surgeons would document their respective portions of the operative service.

• Both would report CPT 22558‑62.

• This meets CPT criteria for true co‑surgery. 

If the second surgeon is participating specifically in the placement of spinal instrumentation, consideration should be given to whether an assistant‑at‑surgery modifier (80 or 82) may be appropriate, since modifier 62 is not allowed on instrumentation codes.

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

Removing a Nasal Pack

Question:

I have looked everywhere and cannot find a CPT code for removing a posterior nasal pack. I found CPT code 30906 for reporting control of a nasal hemorrhage when removing and replacing the pack. Can I report 30906 with Modifier 52 since my doctor is just removing the posterior nasal pack?

Answer:

No, you do not report 30906. There is not a code ore removing a posterior pack unless you are replacing the pack at the same time. If you are only removing a pack then report an E/M CPT code or nasal endoscopy code (31231) whichever is more appropriate.

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