Sleep Endoscopy

Question:

Can I report a nasal endoscopy with a diagnostic drug induced sleep endoscopy?

Answer:

No, when reporting CPT code 42975 for a diagnostic drug induced sleep endoscopy you cannot report a nasal endoscopy 31231 unless it is performed for a separate condition other than sleep disordered breathing and using a separate endoscope.

*This response is based on the best information available as of 10/09/25.

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.

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.

Halo Adjustment?

Question:

What CPT code should be used to adjust a Halo device without anesthesia on postoperative Days 1, 2, and 5? CPT code 20664 was used to bill for the initial application of the Halo device. These adjustments are being performed in preparation for an upcoming surgery.

Answer:

Thank you for reaching out to KZA!

CPT codes 20664 and 20661 both include the application and removal of the Halo device. Any adjustments made during the 90-day global period following the initial procedure are considered part of the global surgical package and are not separately reportable.

*This response is based on the best information available as of 10/09/25.

Modifier 59 vs Modifier 51

Question:

Can you clarify when to use modifiers 59 vs 51?

Answer:

Modifier 59 (or X modifiers) should only be used for a bundling edit to unbundle two codes that are not usually reported together but are appropriate under specific circumstances. If there is no bundling edit between two codes, then modifier 51 is appended to the second code to indicate an additional procedure.

*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.