Non-healing Wound ICD-10

Question:

Should ICD-10 T81.31X– be reported for non-healing healing wounds?

Answer:

Thank you for your great question!

It would not be appropriate to report a non-healing wound with ICD-10 T81.31X, as this code is for the disruption of a closed wound.

There is no straightforward way to look up the ICD-10 code for a non-healing wound, either! That is because there is no specific code.

In this instance, ICD-10 T81.89X– would be assigned for the non-healing wound.

*This response is based on the best information available as of 2/13/25.

Is Scar Revision Still Complex Closure?

Question:

I have a scar revision for the abdomen and was going to assign CPT 13101. My coding teammate told me this is no longer the current coding recommendation. Is scar revision still reported with complex closure?

Answer:

Thank you for your inquiry!

Yes, your fellow coder is correct. At one point, CPT did include scar revision within the complex closure guidelines. However, in 2020, the guidelines associated with closures were changed, and scar revision was removed from the complex closure definition.

To address this change, a coding tip was placed within the CPT book in 2020 stating: “To report scar revision, see the Skin, Subcutaneous, and Accessory Structures, Excision-Benign Lesion subsection codes (11400-11471).”

According to CPT guidelines, scar revision is no longer reported with complex wound closure. Coding recommendations and guidelines are subject to change, so coders must review them and utilize up-to-date coding resources.

*This response is based on the best information available as of 1/30/25.

Donor or recipient site?

Question:

I’m a new plastic surgery coder and still learning. Are muscle flaps coded to the recipient site or coded by the donor site?

Answer:

Thank you for contacting KZA with your question. We understand that this can be confusing. According to CPT guidelines, muscle flap codes are selected based on the donor site.

*This response is based on the best information available as of 1/16/25.

Modifier 80 vs 82

Question:

What is the difference between modifier 80 and modifier 82 when a physician is acting as an assistant during surgery?

Answer:

While both modifier 80 and modifier 82 are used when a physician is actively participating as an assistant to a primary surgeon during a surgical procedure, modifier 82 is used in teaching or university hospitals that have approved Graduate Medical Education (GME) programs for Residents. In these teaching hospitals, there must be documentation indicating that no qualified resident was available to assist, to allow for another physician to act as the assistant surgeon, and then modifier 82 is appended to that assistant surgeon.

*This response is based on the best information available as of 1/2/25.

Can We Append Modifier 59?

Question:

Is it appropriate to report 64718, 64721, and 64719 together on the same hand-right side? We see there is an NCCI edit; should we append modifier 59? 

Answer:
Thank you for contacting KZA with your great question!

You are correct; there is an NCCI bundling edit in place. CPT code 64719 is bundled into 64721.

There is no overlap between an open carpal tunnel release (64721) and open ulnar nerve surgery (64718) at the elbow. Append modifier 51 to the lesser valued code.

There is an overlap between 64721 and 64719 (ulnar nerve decompression at Guyon’s canal). To report CPT codes 64721 and 64719 (ulnar nerve decompression at Guyon’s canal) there must be documentation present of pre-operative diagnostic studies indicating the presence of ulnar nerve pathology. This documentation must be listed in the pre-op diagnosis and the results in the Indication for Surgery paragraph. CPT code 64719 is not reportable with 64721 without the documentation of diagnostic test studies. If present, CPT codes 64721 and 64719 are both reportable. An NCCI edit exists, so modifier 59 is appended in the presence of documentation.

*This response is based on the best information available as of 12/19/24.

Subcutaneous vs Subfascial

Question:

If the provider says in their documentation that they went into the subcutaneous tissue and to the fascia to excise a 4 cm lipoma from the back, is this subfascial? This always trips me up when coding!  

Answer:
In the scenario above, this is only to the fascia, not through or below the fascia. The lipoma excision is only within the subcutaneous tissue.

Based on the scenario presented, the appropriate CPT code is 21931.  

*This response is based on the best information available as of 12/5/24.