Bundling of Drug-Induced Sleep Endoscopy and Turbinate Procedures

Question:

Can you explain why the sleep endoscopy 42975 and any turbinate procedure is bundled? The procedures are done for two completely different reasons—OSA and turbinate hypertrophy.

Answer:

Although CPT® 42975 and turbinate procedures (30801/30802) address distinct clinical conditions such as dynamic airway collapse in OSA versus nasal obstruction from turbinate hypertrophy, they are bundled under National Correct Coding Initiative (NCCI) edits due to shared anatomical access and procedural overlap.

Additionally, CMS coding policy states that when a diagnostic procedure leads directly to a therapeutic intervention during the same operative session, only the therapeutic procedure should be reported. The diagnostic service is considered part of the decision-making process and is not separately reimbursable.

According to CMS and NCCI guidelines, CPT® codes 30801 and 30802 cannot be separately reported when performed in the same session as other nasal or sinus procedures, including:

• For access to the nose or sinuses

• For control of intraoperative bleeding

• When performed concurrently with other nasal procedures

Importantly, modifiers such as 59 or XU are not permitted to bypass this bundling, even if the procedures are performed for separate indications. It is important to remember that turbinate hypertrophy can contribute to sleep-disordered breathing, including OSA. The coding system treats these procedures as components of a single encounter when performed together, and separate reimbursement is not allowed.

*This response is based on the best information available as of 12/04/25.

Reporting 36015

Question:

We have seen some illustrations suggesting the maximum number for reporting 36015 in one session is 5 (3-right(U,M,L), 2 Left(U,L). This method only counts the lobar arteries and excludes counting the segmental arteries. Is it your opinion that each segmental artery can be individually reported? For example, if the provider performed selective catheterization on the right side of the medial basal segment, the posterior basal segment and the lateral basal segment would this count as three (3) total under the lower lobe or count as one (1) since all are in the lower lobe?

Answer:

You can bill 36015 for each distinct selective catheterization, but only when those vessels are legitimately separate branches per the CPT Appendix L vascular-family hierarchy.

Segmental or subsegmental arteries within the same lobar distribution are not separately reportable; they are included in a single unit of 36015 for that lobe. Therefore, selective catheterization of the medial basal, posterior basal, and lateral basal segmental branches would count as one (1) selective catheterization under the right lower-lobe pulmonary artery, not three.

*This response is based on the best information available as of 12/04/25.

Benign Lesion Destruction

Question:

My provider destroyed 5 lesions on the penis, and then 5 lesions on the scrotum and groin area. Can I code 54056 and 17110?

Answer:

Thank you for your question. The destruction of the lesions on the penis are via cryosurgery you will report CPT code 54056. In addition, you may report CPT 17110 for the lesion destructions on the scrotum and groin area. Since the two services are not bundled under NCCI Modifier 51 should be appended to CPT code 17110

*This response is based on the best information available as of 12/04/25.

Closure After a Partial Mastectomy, Code 19301

Question:

Adjacent tissue transfers, 14000 series to include 14301 and 14302 with 19301 Mastectomy. I see where you clarify 14000 (ADJ flaps) to eliminate dead space is inherent to a mastectomy procedure. My question is does this include codes 14301 and 14302? I'm asking because there was a Q & A 2017 CPT Assistance Article stating "14000 and 14001 are not reported separately because simple, intermediate and complex layered closure is included in the work represented by code 19301". As such, our guidance is that it is ok to bill separately for codes 14301 and 14302 with 19301 when the defect is larger than 30 sq cm.

Answer:

This is a common misunderstanding. It does not matter how large a defect remains after a partial mastectomy, closure by a local advancement flap or an oncoplastic repair do not support an adjacent tissue transfer. Codes 14301, 14302 should not be reported for these closures regardless of the size of the defect.

See below for guidance from the American College of Surgeons national coding courses.

• There are no additional codes for closure after a partial mastectomy, code 19301

• Elimination of dead space is inherent to a mastectomy procedure.

• Complex closure (13100-13102, 13131-13133) is included in any mastectomy procedure.

• Local advancement flaps and oncoplastic repair are included in a mastectomy procedure.

• Adjacent tissue transfer (ATT) (14000-14302) is not commonly performed with a mastectomy (e.g., 19120, 19125). A closure defined as a local advancement flap or an oncoplastic repair is most commonly a skin advancement flap that does not meet the definition of a true ATT.

• If a complex repair is substantially greater than typically required, it may be appropriate to append modifier 22, Increased Procedural Services, to the mastectomy code. Documentation must support the substantial additional work and the reason for the additional work (i.e., increased intensity, time technical difficulty of the procedure, severity of patient’s condition, physical and mental effort required.

*This response is based on the best information available as of 12/04/25.

Injections and E/M Visits

Question:

How do you code for an unplanned injection as well as the E&M service necessary to make the decision to perform the injection?

Answer:

The answer to this question depends upon if you are providing a significant and separate evaluation and management service in addition to an injection, and not whether the injection was planned or unplanned.  Every minor procedure has time for pre-service evaluation included in the value of the procedure code. Medicare and other payors have become concerned that E/M’s are being routinely reported with minor procedures without considering if the extent of the visit was truly more than the pre-service evaluation already included in the procedure. Just because an injection is unplanned does not automatically allow for an E/M visit to be billed. There must be a significant and separately identifiable E/M service above and beyond the injection. Please listen to our KZA KAST Modifier Monday podcast on Modifier 25 for additional information.

https://monday.transistor.fm/

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

0232T

Question:

Hi. We would like a little guidance on what is included in the PRP code 0232T. If the PRP injection is rendered in a tendon and a tendon fenestration/tenotomy is performed, is the fenestration included in the PRP code? Also, if PRP is being utilized to hydrodissect a tendon, is the hydrodissection included in the PRP injection?

Answer:

Thank you for asking KZA!

After creating platelet-rich plasma (PRP) from a patient’s blood sample, that solution is injected into the target area, such as an injured knee or a tendon. In some cases, the clinician may use ultrasound to guide the injection. The purpose is to promote and/or accelerate the healing process of the tendon and tissue regeneration. 

Both fenestration and hydro-dissection are also performed to promote healing of the tendon and surrounding tissue, and when performed in conjunction with PRP injection, should not be reported separately.  

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