X-Ray Documentation

Question:

Is it required to have the specific x-ray views noted in the documentation or will the code description of the number of views be sufficient?

Answer:

Thank you for asking KZA! The specific views performed must be documented in the radiology findings. The order for the x-ray that contains the description of the number of views ordered, is not sufficient. Best practice wording example: "X-ray of the left knee obtained in AP, lateral, and sunrise views. Findings: Joint space narrowing with osteophyte formation, no acute fracture. Impression: Degenerative joint disease." 

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

Shoulder Capsulorrhaphy

Question:

I am looking for guidance regarding CPT codes 23462, 23465, 23466. I am not really finding anything. I have a provider that is doing all three procedures. Per NCCI edits, it indicated that only 23466 should be charged. Is this because it says any type multi-directional? Does that mean this code would include multiple capsulorrhaphies? I am trying to figure out if only code 23466 should be charged, or if there are instances when more than one open capsulorrhaphy code could be charged? Thank you.

Answer:

Thank you for asking KZA! CPT codes 23466, 23465 and 23462 are mutually exclusive per NCCI edits. They all represent capsulorrhaphy for instability- just different techniques. Even if the surgeon performs elements of more than one technique you should code the single most comprehensive/definitive procedure performed. Reporting more than one capsulorrhaphy code is not appropriate here since these procedures are alternative methods to treat the same pathology in the joint. 

*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.

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.

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.