Laparoscopic Approach for Shunt

Question:

Can unlisted code 49320 or 49329 be coded along with 62223-62 for a General Surgeon who was a co-surgeon for ventriculo-peritoneal shunt creation if he used a laparoscopy?

Answer:

No, reporting either 49320 or 49329 for the laparoscopic approach is not appropriate.

According to the December 2012 issue of CPT Assistant, code 62230 with modifier 62 may be used by a general surgeon performing the procedure laparoscopically. The provided explanation states that the essential portion of the operation remains the same, and the incision size is not a factor.

Based on this guidance, the correct coding for this scenario is 62223-62 for both the general surgeon and the neurosurgeon.

*This response is based on the best information available as of 12/18/25.

Complication: Back to OR

Question:

Can we bill separately for taking a patient back to the OR on postoperative day 2 to explore and repair a postoperative hemorrhage? I’ve heard that complications like this are usually included in the payment for the original surgery.

Answer:

Yes, you can bill for this. Both CPT and Medicare guidelines allow separate billing when a patient returns to the OR to treat a complication.

In this case, report the procedure code(s) for the services performed to address the postoperative hemorrhage. Be sure to append modifier 78 to indicate an unplanned return to the OR and assign the appropriate ICD-10 code for postoperative hemorrhage.

Thank you for reaching out to KZA regarding your inquiry.

*This response is based on the best information available as of 12/18/25.

Hydrodissection of the Cubital Nerve

Question:

My provider is doing an in office hydrodissection of the cubital nerve. I am only finding a 64999 unlisted code. Is there a better code for this procedure?

Answer:

Selecting the correct code depends upon what and why the procedure is being performed. CPT 64718 requires a neuroplasty and/or transposition of the ulnar nerve at the elbow. If this is not being performed, then 64999 would have to be coded. 

*This response is based on the best information available as of 12/18/25.

Does a Figure-Eight Suture Qualify as Intermediate Repair?

Question:

I was told a figure eight suture is considered intermediate closure. Is this correct?

Answer:

A figure-eight suture is just a closure technique, not a repair classification. The depth of the wound and layers repaired determine whether the closure is coded as simple, intermediate, or complex.

*This response is based on the best information available as of 12/18/25.

Actively Assisting PA

Question:

What are the documentation requirements for a teaching physician when both a resident surgeon and a PA first assist are present in the operating room? The PA is actively assisting, and both individuals are noted in the operative report.

Answer:

In a teaching facility, if a resident acts as assistant and if that resident is considered (by the teaching physician) to be qualified to assist in the case, no third provider will be reimbursed as an additional assistant. If, however, the teaching physician attests that no qualified resident was available to act as an assistant, a PA may be billed as assistant. The resident may still be present for teaching purposes and listed as participating in the case.

The definition of “qualified resident“ is case specific. It may be that a resident is not physically available or that the available resident is considered (by the teaching physician) to not be clinically qualified for the specific operative case. A teaching facility’s compliance department may have specific language for an attestation statement.

*This response is based on the best information available as of 12/18/25.

Use of 15740 for Closure Following Pituitary Tumor Excision

Question:

My physician performed a pituitary tumor excision and reported CPT code 62165-62. The ENT surgeon also performs a pedicled flap (15740). The neurosurgeon performs a fat graft for the closure. Can 15740 also be billed for the ENT surgeon, and if so, would a 59 modifier be needed?

Answer:

In skull base cases, when the ENT harvests a nasoseptal flap to repair or prevent a cerebrospinal fluid (CSF) leak during an endoscopic pituitary excision, this work is considered part of the procedure. According to CPT Assistant (December 2017, page 14), closure of a CSF leak—including the use of a nasoseptal flap—is included in the work described by 62165 and should not be separately reported. Therefore, 15740 would not be separately billable in this scenario, and modifier 59 would not apply.

*This response is based on the best information available as of 12/18/25.