KX Modifier?

Question:

Should the KX modifier be billed on all feminization procedures in the setting of gender dysphoria? For example, feminization rhinoplasty for a trans female patient assigned male at birth.

Answer:

In the context of gender-affirming surgery, the KX modifier should be appended to procedure codes that are gender-specific—particularly when there is a mismatch between the patient’s gender marker and the procedure or diagnosis code. This modifier alerts the payer that the coding is intentional and not an error.

In the example provided—feminization rhinoplasty for a trans female patient—there is typically no conflict between the gender marker and the procedure or diagnosis code. As such, the KX modifier would generally not be necessary.

It’s important to note that modifier KX indicates that “requirements specified in the medical policy have been met.” This modifier is not exclusive to gender-affirming procedures and may be used in other contexts.

In closing, always consult the payer-specific policy and your internal coding compliance guidelines to ensure accurate and compliant use of modifiers.

Thank you for contacting KZA!

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

Automated Skin Cell Suspension Autograft Procedures

Question:

A provider at our facility has begun performing the new 2025 skin cell suspension autograft procedure. During this process, automated preparation of the autograft is performed, including enzymatic processing, disaggregation of skin cells, and filtration of harvested tissue. Currently, there is no specific CPT code that describes this work. Since we are advised to report an unlisted code for this service, what comparative CPT code would you recommend using to help determine appropriate reimbursement?

Answer:

For SCSA procedures using automated preparation devices, report the harvest codes (15011-15012) and application codes (15015-15018) based on the surface areas involved. Do not report the preparation codes 15013-15014 when automated devices are used, as these codes are exclusively reserved for manual mechanical disaggregation of skin cells.

According to CPT Assistant (December 2024, June 2025), the Skin Replacement Surgery subsection guidelines explicitly state that codes 15013-15014 "are not reported if the harvested skin is nonmanually processed (i.e., using automation)." When automation is used, only the physician's work in harvesting and application is separately reportable.

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

14000 and 19301 for Partial Mastectomy?

Question:

Should cpt code 14000 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10 SQ CM be billed with cpt code 19301 MASTECTOMY; PARTIAL? Insurances tend to disallow it stating it is included in 19301. This is how our surgeon describes 14000, a parenchymal flap advancement was used to close, there is minimal breast parenchyma left at the inferior margin. Advancing this into the lumpectomy cavity does create some distortion along the inframammary fold. Therefore, the breast tissue both above and below the lumpectomy cavity is released from the underlying chest wall. They form a well vascularized broad based pedicle. This is advanced into the lumpectomy cavity and secured together with interrupted 3-0 Vicryl sutures. Approximately 10 sq cm of tissue are mobilized in this fashion. Thank you for your help.

Answer:

No, 14000 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10 SQ CM is not reported with a partial mastectomy (lumpectomy) code 19301 for a local advancement flap, which is what is described in your question

Elimination of dead space is inherent to a mastectomy procedure. Local advancement flaps and oncoplastic repair are included in a mastectomy procedure.

*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.

Secondary Closure?

Question:

I’m a new coder, and my physician closed a fasciotomy wound. I’m unsure what to do with this, so I am seeking some much-needed guidance. I’m looking at 13160. The surgeon debrided tissue and closed the wound.

Answer:

Thank you for reaching out—great job identifying CPT 13160. You're on the right track. If this is a secondary closure of a fasciotomy wound, CPT 13160 (Secondary closure of surgical wound or dehiscence) is appropriate.

*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.