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.

Exploratory Laparotomy with Other Procedures

Question:

Can we code for an exploratory laparotomy if we then perform another procedure that we did not know was necessary prior to the laparotomy?

Answer:

No, exploratory laparotomy is always included in other definitive procedures.

*This response is based on the best information available as of 04/07/26.

E/M Leveling on a Recurrent Keloid

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 03/05/26.

Repair of Pyloric Channel Ulcer with Graham Patch

Question:

Hello, we are reporting repair of pyloric channel ulcer with 43840 and the omental flap with 49905, we keep getting feedback from an external auditor that 49905 is not separately reportable. Could you please clarify how this procedure should be reported and the reasoning?

Answer:

Code +49905 is not reported separately when used to secure a suture line in an ulcer repair as you described, or for securing an anastomosis in colon resection as another example.

CPT code +49905, omental flap, intraabdominal, is intended for an omental flap to reconstruct a defect, for example after lesion resection, to fill an anatomic defect resulting from that resection.

*This response is based on the best information available as of 02/05/26.

Reduction of Hernia Sac

Question:

General surgeon performs a laparoscopic repair of a hiatal hernia, reducing the hernia sac, constructs a Toupet fundoplication, and places mesh. He states 43282 can be reported regardless of the "type" of hiatal hernia, because the work is the same. Is he correct, and 43282 can be reported for repair of a sliding Type 1 hiatal hernia?

Answer:

Great question! Reduction of the hernia sac and a fundoplication does not automatically support code 43282. Code 43281 without mesh and 43282, with mesh, require the work to repair a true paraoesophageal hernia, not a less complex hiatal hernia. The documentation should describe the additional work needed, for example reducing the stomach from the thoracic cavity.

*This response is based on the best information available as of 01/22/26.

Diastasis Recti Repair

Question:

What is the recommendation for coding an open Diastasis Recti repair, when it is the only procedure performed?

Answer:

There is no specific CPT code for open repair of a Diastasis Recti. If it is the only procedure performed, it is reported with an unlisted code, 49999 or 22999. If it is performed at the same session as an abdominal hernia repair, it is considered part of the reconstruction of the hernia repair and is not separately reported.

*This response is based on the best information available as of 01/08/26.