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.

Two Surgeons, Same Practice, Co-Surgery?

Question:

I have a case where two surgeons from the same practice are reconstructing the abdominal wall following tumor resection. They each perform their own side of the component separation, surgeon A on the right and surgeon B on the left. Each surgeon dictated their own op-notes for the side they performed, and now they want to bill as co-surgeons. I’m unsure if this is appropriate, so I seek KZA’s advice.

Answer:
Great question! While your surgeons each dictated their operative notes, this alone does not support co-surgery, modifier 62. Co-surgery from a surgeon's perspective is different from a coding perspective.

From a coding perspective, co-surgery involves two surgeons, typically of different specialties, with different skill sets, each performing separate portions (s) or parts of a procedure as defined by a CPT code.  Each surgeon would dictate their own operative note detailing their portions of the procedure performed. Again, this typically involves surgeons from different specialties, not two surgeons of the same specialty.

In the scenario above, two plastic surgeons perform one side of this bilateral component separation.

They should each be reporting their own CPT code,15734.

• Surgeon A: 15734

• Surgeon B: 15734 -XP

*Modifiers as directed by your payor. CPT code 15734 does not allow for RT/LT.  

*This response is based on the best information available as of 11/14/24.

Converting Dimensions

Question:

My surgeon placed integra and dictated the integra dimensions in inches instead of centimeters. Can the inches be converted into centimeters to determine code selection?

Answer:

Thank you for your inquiry.  

From a best practice standpoint, the physician is encouraged to document the size based on CPT requirements, e.g. centimeters in this scenario.  The risk is that an error may be made in performing the conversion if this activity is not regularly performed.

*This response is based on the best information available as of 10/31/24.