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.

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.

Actively Assisting PA

Question:

What are the documentation requirements for a teaching physician when both a resident surgeon and a PA first assist are present in the operating room? The PA is actively assisting, and both individuals are noted in the operative report.

Answer:

In a teaching facility, if a resident acts as assistant and if that resident is considered (by the teaching physician) to be qualified to assist in the case, no third provider will be reimbursed as an additional assistant. If, however, the teaching physician attests that no qualified resident was available to act as an assistant, a PA may be billed as assistant. The resident may still be present for teaching purposes and listed as participating in the case.

The definition of “qualified resident“ is case specific. It may be that a resident is not physically available or that the available resident is considered (by the teaching physician) to not be clinically qualified for the specific operative case. A teaching facility’s compliance department may have specific language for an attestation statement.

*This response is based on the best information available as of 12/18/25.