CPT 44130 “Separate Procedure” Designation

Question:

CPT 48150 describes a pancreatectomy, proximal subtotal with total duodenectomy, partial gastrectomy, choledochoenterostomy, and gastrojejunostomy, with pancreatojejunostomy. CPT 44130 describes an enteroenterostomy, an anastomosis of the intestine, with or without cutaneous enterostomy, and is designated by CPT as a “separate procedure.”

According to NCCI edits, there is a procedure-to-procedure (PTP) conflict between 44130 and 48150 when performed during the same encounter, which can be bypassed with modifier 59. If a provider routinely performs an enteroenterostomy in conjunction with the Whipple procedure to prevent future bile reflux—a common postoperative complication—is it appropriate to append modifier 59 to 44130?

Given that these procedures are frequently performed together, could the enteroenterostomy be considered an integral component of the Whipple procedure, rather than a distinct, independent, or unrelated service? While the Whipple procedure description does not specifically include an enteroenterostomy, it does involve bile redirection via choledochoenterostomy. The enteroenterostomy similarly aids in bile flow redirection, serving as an additional step to reduce bile reflux.

In light of this, should these procedures be routinely unbundled and billed together?

Answer:

While modifier 59 can technically be used to bypass the NCCI edit between CPT 44130 and CPT 48150, it is not generally appropriate to routinely unbundle and report these codes together.

According to Medicare NCCI guidelines and CPT principles regarding “separate procedures,” CPT 44130 should only be reported when it is performed independently or is clearly distinct from other procedures. In the context of a Whipple procedure (CPT 48150), the enteroenterostomy is typically considered an integral part of the overall surgical approach, especially when performed to prevent bile reflux—a known complication.

CPT 48150 is the Column 1 (comprehensive) code, and CPT 44130 is the Column 2 (component) code. The “separate procedure” designation for 44130 indicates that it should not be reported in conjunction with a more extensive procedure unless it is truly separate and unrelated.

Therefore, unless there is clear documentation that the enteroenterostomy was performed for a distinct reason unrelated to the Whipple procedure, routinely appending modifier 59 to report both codes together would not align with coding guidelines.

*This response is based on the best information available as of 11/20/25.

Does a Figure-Eight Suture Qualify as Intermediate Repair?

Question:

I was told a figure eight suture is considered intermediate closure. Is this correct?

Answer:

A figure-eight suture is just a closure technique, not a repair classification. The depth of the wound and layers repaired determine whether the closure is coded as simple, intermediate, or complex.

*This response is based on the best information available as of 11/06/25.

Coding for Traumatic Serosal Tear

Question:

How do you recommend coding for a traumatic transverse colon serosal tear? My coder used "repair of transverse colon." I am getting push back because I said it was a clean case (no spillage of GI contents and no contamination." I am told I can't use Clean classification because of how it was coded. Please advise!

Answer:

Serosal tears after trauma are not separately reported. They are included in the primary procedure. The colon was not lacerated/injured and was not repaired so colon repair may not be reported.

*This response is based on the best information available as of 10/23/25.

Pyogenic Granuloma

Question:

Hello! Could KZA clarify if the excision of a pyogenic granuloma (lobular capillary hemangioma) would be assigned to a code from the musculoskeletal or integumentary system? We have seen some conflicting information.  

Answer:

Thank you for reaching out to KZA!

The origin of the lesion will direct you to the appropriate code selection.

According to CPT:

• Lesions of cutaneous origin are appropriately reported with the excision of lesion integumentary codes (114xx & 116xx).

• Lesions of non-cutaneous origin are appropriately reported with the excision of tumor codes from the musculoskeletal section of CPT (2xxxx).

Pyogenic granulomas are benign, generally considered of cutaneous origin, and reported with a 114xx benign lesion code. If the documentation is unclear, it is best practice to query the surgeon for clarification.

*This response is based on the best information available as of 10/09/25.

Reporting Modifiers with Unlisted Codes

Question:

Can modifiers be reported with unlisted CPT codes?

Answer:

Yes, modifiers can be appended to unlisted CPT codes.

In 2024, CPT clarified this by updating the introduction guidelines for unlisted procedures and services. These updates were further explained in the January 2024 issue of CPT Assistant, which addressed the new and revised text and the standardization of reporting unlisted CPT codes across the CPT code set.

Illustration of modifiers that may be appropriately applied includes:

• Laterality modifiers – e.g., RT (right), LT (left)

• Bilateral procedure modifier – 50

• Role-based modifiers – e.g., 62 (two surgeons), 80 (assistant surgeon), 82 (assistant surgeon when qualified resident not available), AS (non-physician surgical assistant)

• Multiple or distinct procedure modifiers – e.g., 51 (multiple procedures), 59 (distinct procedural service)

• Global modifiers – e.g., 58 (staged or related procedure), 78 (return to operating room for related procedure), 79 (unrelated procedure or service)

This is not an all-inclusive list of modifiers that may be appropriately applied to unlisted CPT codes. For complete and up-to-date information, one should refer to current CPT guidelines and payer-specific policies.

Please note: Modifiers that describe an alteration of a service or procedure, such as modifier 52 (reduced services), are not appropriate for use with unlisted codes. The same applied to modifier 22 (increased procedural services).

*This response is based on the best information available as of 9/22/25.

Is CPT 20660 separately reportable with 61313?

Question:

My surgeon wants to bill CPT 20660 and CPT 61313. Is 20660 appropriate to report in addition?

Answer:

Great question! Thank you for asking KZA!

If you review the CPT descriptor for CPT 20660, this is a designated separate procedure.

First, let’s review what a “separate procedure” is:

CPT Says: “Some of the procedures or services listed in the CPT codebook that are commonly carried out as an integral component of a total service or procedure have been identified by the inclusion of the term “separate procedure.” The codes designated as “separate procedure” should not be reported in addition to the code for the total procedure or service of which it is considered an integral component.

However, when a procedure or service that is designated as a “separate procedure” is carried out independently or considered to be unrelated or distinct from other procedures, report the code in addition to other procedures/services by appending modifier 59 to the specific “separate procedure” code. This indicates that the procedure is not considered to be a component of another procedure, but is a distinct, independent procedure. This may represent a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries).”

That said, this means in practice that if a code description includes the term “separate procedure,” if that procedure is in the same anatomic area as a more comprehensive procedure (for example, application of a headframe followed by a craniectomy), only the more comprehensive procedure, the craniectomy (61313), is reported.

*This response is based on the best information available as of 9/25/25.