Coding Conundrum: Coding for Facet Cyst Aspiration

Question:

We are confused by AMA recommendations for the aspiration of a facet cyst. While researching, we found two CPT Assistants (2011 and 2017) advising to use an unlisted code, 64999. The Clinical Examples in Radiology CPT Assistant, February 2024 instructs to use CPT code 22899, not 64999. The rationale cited for recommending CPT code 22899 is because the procedure does not involve entering the facet joint and facet cysts are not considered to originate in the nervous system.

Which unlisted code does KZA recommend?

Answer:

Thank you for your detailed inquiry. We understand your confusion. KZA noted this discrepancy earlier this year while researching whether the AMA had published the updated guidance since the 2017 article.

KZA appreciates that both sources recommend an unlisted code. CPT code 64999 represents an unlisted procedure within the nervous system, while CPT code 22899 applies to unlisted spinal procedures

According to the latest guidance outlined in Clinical Examples in Radiology, Fall 2024, KZA recommends CPT code 22899 (unlisted procedure, spine) as the most appropriate code for aspiration of a facet cyst.

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

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.

Infected Total Shoulder Arthroplasty

Question:

Could KZA help me with an orthopedic surgery coding question? Thank you in advance. What code should be used if the provider performed irrigation and debridement with polyethylene exchange in an infected total shoulder?

Answer:

Thank you for your question. Without reviewing the operative note, KZA cannot address a specific case but can help you with general guidelines.

CPT Assistant from September 2021 addresses scenarios for revision arthroplasty. These scenarios are for the hip and knee but are relevant to all other joint arthroplasty procedures, and the same logic is applied to joints outside of the hip and knee.

If there is an exchange of a component in a TJA, CPT Assistant September 2021 guidelines state “when only a single modular component is revised, report the single component with modifier 52.” Therefore, based on your question, (not reviewing the operative note), it is appropriate to code for a single component revision of (23473) appending modifier 52, Reduced Services.

*This response is based on the best information available as of 8/28/25.

Intraoperative Nerve Stimulation

Question:

We are having difficulty locating a code. One of our hand surgeons is performing therapeutic nerve stimulation intraoperatively for regeneration of nerve. Is this reportable, and if yes, what is the code?

Answer:

Great question and thank you for asking us!

Two new Category III CPT codes have been introduced: 0882T and 0883T. These codes became effective on July 1, 2024, and are included in the 2025 CPT manual.

• 0882T – Intraoperative therapeutic electrical stimulation of a peripheral nerve to promote nerve regeneration, including lead placement and removal, upper extremity, minimum of 10 minutes; initial nerve

• 0883T – Intraoperative therapeutic electrical stimulation of a peripheral nerve to promote nerve regeneration, including lead placement and removal, upper extremity, minimum of 10 minutes; each additional nerve

Key points to note about these Category III codes:

• They are specific to the upper extremity

• Require a minimum of 10 minutes of stimulation

• Are add-on codes and must be reported in conjunction with a primary procedure

*This response is based on the best information available as of 8/14/25.

27134 vs. 27137

Question:

What is the correct way to bill for a hip arthroplasty revision where the full acetabular component is replaced, and a new femoral head is placed, but nothing is done to the femoral stem?

Answer:

Thank you for asking KZA!

Admittedly, this is a frustration.

The CPT descriptor for 27137 is for revision of hip arthroplasty, acetabular component only. Based on the scenario described, it would not be appropriate to report 27137, as both the acetabular component and femoral head were revised.

The CPT descriptor for 27134 is for revision of hip arthroplasty, both components. A hip arthroplasty comprises the acetabular and femoral components (femoral head and femoral stem).

From a correct coding standpoint, both hip arthroplasty components have not been completely revised – we only have the acetabular and part of the femoral component (femoral head). Therefore, it would be appropriate to append modifier 52 to reflect the reduced services.

At the time of this writing, this is the current guidance from CPT.

*This response is based on the best information available as of 7/31/25.

10180 vs. 23930

Question:

Our surgeon did ORIF of a humeral shaft fracture. A few weeks later, the patient developed a postoperative infection. Diagnosis is 'Infected hematoma, left humerus'.

Excerpt from note:

“I removed all the sutures from the skin and the subcutaneous and immediately encountered a large amount of purulent material. This was completely evacuated. Multiple cultures were sent for culture. I debrided starting with the skin down to the level of bone and washed out with a combination of saline…...”

I considered submitting CPT 23930 Incision and drainage, upper arm or elbow; deep abscess or hematoma. CPT 10180 Incision and drainage, complex, postoperative wound infection could also work. Which one would be a better choice here, considering it was a musculoskeletal procedure?

Answer:

Thank you for asking KZA!

Some seemingly more straightforward cases that cross coding desks often provoke deep thought. KZA can appreciate reviewing and considering codes 10180 vs. 23930 for this scenario.

Based on the information in the excerpt from the note in the inquiry, KZA would assign CPT 23930.

The rationale: The tissues involved were deeper than the skin and deeper subcutaneous tissues for this incision and drainage. Additionally, debridement is considered included in CPT 23930.

*This response is based on the best information available as of 7/17/25.