X-Ray Documentation

Question:

Is it required to have the specific x-ray views noted in the documentation or will the code description of the number of views be sufficient?

Answer:

Thank you for asking KZA! The specific views performed must be documented in the radiology findings. 

Best practice wording example: "X-ray of the left knee obtained 3 views" based on CPT nomenclature.

Clinical Examples in Radiology Fall 2024 describe the views as (eg, AP, lateral, and sunrise, and posteroanterior) views but state "code selection depends on the number (not the type) of views."

Findings: Joint space narrowing with osteophyte formation, no acute fracture. Impression: Degenerative joint disease." 

It is important to document clinical history and confirmed or definitive diagnosis(es). 

*This response is based on the best information available as of 10/23/25.

Coding for Traumatic Serosal Tear

Question:

How do you recommend coding for a traumatic transverse colon serosal tear? My coder used "repair of transverse colon." I am getting push back because I said it was a clean case (no spillage of GI contents and no contamination." I am told I can't use Clean classification because of how it was coded. Please advise!

Answer:

Serosal tears after trauma are not separately reported. They are included in the primary procedure. The colon was not lacerated/injured and was not repaired so colon repair may not be reported.

*This response is based on the best information available as of 10/23/25.

Preventative Skin Check Coding

Question:

Can you clarify visit elements and review of systems are required for a preventative skin check? I have been told a full ROS is required for a preventative skin exam, as well as, medical and family history, lifestyle counseling, and age/gender appropriate screening performed. I believe dermatology to be problem oriented and a skin cancer screening vs preventative has been a huge gray area for me. Can you clarify the difference and requirements to be truly a dermatology preventative visit?

Answer:

The confusion arises because full-body skin cancer screenings in dermatology are rarely actual preventive medicine visits. Dermatology is specialty care, not primary care. Preventive medicine codes are typically reserved for primary care physicians providing comprehensive preventive services not performed in Dermatology, as they would be conducted in primary care. If you're performing a skin exam, you're not meeting the requirements for a preventive medicine visit (which requires multi-system examination and comprehensive counseling beyond just skin).

A dermatology skin cancer screening is appropriately coded as a problem-oriented visit with documentation matching the medical necessity and level of service provided based on either medical decision making or time.

For a routine skin cancer screening in dermatology, you should:

• Code as a problem-oriented visit (most commonly 99203/99213)

• Document risk factors justifying the exam

• Perform a clinically appropriate history and exam

• Document the assessment and plan of care relative to the history and examination

You will only bill a preventive medicine code if you provide comprehensive age-appropriate preventive services as a primary care provider would, which is not the typical dermatology scenario

*This response is based on the best information available as of 10/23/25.

LCD Clarification

Question:

Does the LCD L33622 Pain Management - Injection of tendon sheaths, ligaments, ganglion cysts, carpal and tarsal tunnels apply to trigger finger injections? I am reading the LCD and the title but not seeing where it applies specifically to trigger finger questions. 

Answer:

Yes, the LCD does apply to trigger finger injections. You are correct, that in the actual LCD there is not a specific reference to this diagnosis, including the title.  

Look at the links in the Associated Diagnosis section of the LCD. You will find the following link which takes you to the coding and billing requirements. CPT code 20550 and the diagnosis codes for trigger finger are listed in this document. 

 A52863 - Billing and Coding: Pain Management - injection of tendon sheaths, ligaments, ganglion cysts, carpal and tarsal tunnels. 

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52863&ver=51 

*This response is based on the best information available as of 10/23/25.

How Do You Bill for H&P on the Same Date as an EVAR?

Question:

I saw a patient in the office, performed an examination, and scheduled an EVAR for the next week in the hospital.  The day of surgery, the hospital requires that I document an H&P on the day of the procedure. Can I bill an E/M for the required H&P?

Answer:

Thank you for reaching out to KZA! Because the EVAR procedure has a 90-day global period, it is considered a major procedure.  You cannot bill a separate E/M service for the history and physical on the day of the EVAR procedure if it's solely the pre-procedure H&P required for hospital admission/surgery.

Chapter 1 of the National Correct Coding Initiative states: “If a procedure has a global period of 90 days, it is defined as a major surgical procedure. If an E&M is performed on the same date of service as a major surgical procedure for the purpose of deciding whether to perform this surgical procedure, the E&M service is separately reportable with modifier 57. Other E&M services on the same date of service as a major surgical procedure are included in the global payment for the procedure and are not separately reportable”

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

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.