Excisional Debridement (1104x) vs. Surgical Preparation (1500x)

Question:

Our surgeon is taking a patient to the OR to excise a surgical wound dehiscence, which will be closed with a skin graft. We are looking at debridement codes 1104x and the skin graft codes (15xxx). Are we on track?

Answer:

Thank you for reaching out to KZA!

You're on the right track with the skin graft codes (15xxx series). However, for the debridement portion, it's important to note that the 1104x codes are typically used when the wound is being debrided with the expectation of healing by secondary intention—that is, without primary closure or grafting.

In your scenario, since the wound will be closed with a skin graft, the more appropriate coding would come from the surgical preparation code set (15002–15005). These codes are specifically intended for excisional preparation of a wound bed before grafting or other definitive closure.

*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.

Complex Close with FTSG

Question:

We want to confirm with KZA if a complex closure with extensive undermining is required to close the donor site where an FTSG was taken. Can we separately report the closure?

Answer:

No, this is not separately reportable. The CPT descriptors for the full-thickness skin grafts (FTSG) code set specifically state “including direct closure of the donor site”.

*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.

ICD-10 - Skin Necrosis Following Breast Reconstruction

Question:

I’m having difficulty with the ICD-10 code assignment. Can KZA provide some guidance? A patient following breast reconstruction presented during the postoperative period with skin necrosis at the incision site.

Answer:

Thank you for your question!

Based on the information provided, two ICD-10 codes would be reported: one for the postoperative complication of the skin and subcutaneous tissue, ICD-10 L76.82, and one for skin necrosis, ICD-10 I96.

Some may stop at L76.82 alone. However, ICD-10 provides additional instruction located under L76.8. The instruction states, “Use additional code, if applicable, to further specify the disorder.”

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

Wound Vac Billing

Question:

Can a wound vac be billed if a wound is partially sutured and partially left open?

Answer:

Billing for a wound vac depends on whether the wound is considered open or closed. According to coding guidelines, negative pressure wound therapy (NPWT) codes (97605-97608) are only reportable when placed at an open wound site. If a wound is partially sutured but still has an open portion, the wound vac may be billable, provided the documentation supports its use for the open wound. However, if the wound vac is applied over a closed wound, it is generally considered a dressing and not separately billable.

To ensure proper billing, documentation should clearly indicate the wound's size, depth, and the necessity of NPWT. Some payors may have specific rules, so checking with the relevant insurance provider or Medicare guidelines is recommended.

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