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.

Decision for Surgery: Always a Level Five?

Question:

If the surgeon documents the decision for surgery and places the standard risk paragraph for that surgery, is this automatically a high level of risk?

Answer:

Thank you for your inquiry as this is not an uncommon question; we discuss this at length in the KZA coding courses.

There are two risk levels associated with the decision for surgery:

• Moderate: Decision for Surgery without documentation of procedure risks and patient specific risks for that surgery.

• High Risk: Decision for Surgery with documentation of procedure risks and patient specific risks for that surgery.

Remember, this Risk Element is only of the three Medical Decision Making (MDM) Elements. To meet a level four or level five encounter, two of the three MDM Elements either need to be at or meet the associated E&M level.

1. The number and complexity of problems addressed.

2. The amount and/or complexity of data to be reviewed and analyzed.

3. The risk of complications and/or morbidity or mortality of patient management.

*This response is based on the best information available as of 7/03/25.

Erector Spinal Block with Discectomy

Question:

Our surgeon states in the procedure title “Fluoroscopic Erector Spinae Block (ESP) L5”. The documentation supports this as performed bilaterally at L5 prior to the surgical incision. Is this separately reportable?

Answer:

Thank you for your inquiry. It appears you have good documentation; however, this block is inclusive of the surgical procedure when performed by the operating surgeon. The timing of this (pre-incision) and fluoroscopically vs post discectomy, does not change the injection as being inclusive.  

*This response is based on the best information available as of 6/19/25.

Postoperative Pain Block by Surgeon

Question:

This question may fall outside the interventional pain questions typically submitted to KZA.

Our surgeon is performing a total knee replacement and a postoperative pain block on a Medicare patient. Can we report the block in addition to the total knee arthroplasty procedure?

Answer:

Thank you for your submitted question!

Both CPT and CMS consider postoperative pain management by the physician performing the surgical procedure to be included in the global surgical package and not separately reportable.

Based on the submitted scenario, the surgeon's appropriate coding is 27447 for the total knee arthroplasty.

*This response is based on the best information available as of 5/22/25.