There are two codes for cerumen removal 69209 Removal impacted cerumen using irrigation/lavage, unilateral 69210 Removal impacted cerumen (separate procedure), 1 or both ears Key points Document the medical necessity for cerumen removal (patient’s complaints, diminished hearing, physical exam) Document the results: was the procedure successful? Whether it is a clinical staff member or practitioner […]
Surgical procedures, modifiers, and the global package
CMS and CPT both define the components of the global surgical package to include certain pre-op, intra-op, and post-op services. Learn what is included in the single payment, what may be reported separately and how to do it.
Removal of a Foreign Body
Integumentary 10120 Incision and removal of foreign body, subcutaneous tissues; simple 10121 Incision and removal of foreign body, subcutaneous tissues; complicated Note that incision is required. Musculoskeletal From Principles of CPT® Coding, “If fascia is penetrated and a foreign body to be removed is within the fascia, subfascia or muscle, use an anatomic-specific code in […]
Lesion Destruction Tip Sheet
CPT® does not make it easy to locate codes for destruction of lesion(s). These codes are found in multiple chapters throughout the CPT® book, and are classified by a variety of factors (size, method of destruction, type (pre-malignant/malignant/benign), etc.) Accurate coding is essential to accurate payment. This tip sheet was created to help you quickly locate the correct CPT® code for lesion destruction.
Commonly Performed Procedures in Primary Care | Reference Sheet
These reference sheets for minor procedures include common CPT® codes, descriptions, current work and non-facility RVUs, and global days for quick reference. The first chart includes codes 10060-11443, the second 11600-17111, and the third 20550-54056.
Modifier 25
Use of Modifier 25 may be applicable when an E/M service is provided on the same day as a procedure, a preventive medicine service, or other medical service or procedure. Use this quick reference sheet to determine when to use modifier 25, and which code to append it to.
Take the guesswork out of Separate Procedures, Global Packages, and E/M Billing Rules
Navigating medical coding can be a challenge, especially when it comes to understanding when procedures and Evaluation & Management (E/M) services are separately billable. Three key concepts—separate procedures, global surgical packages, and E/M modifiers play a critical role in accurate and compliant billing. Let’s break them down. Separate Procedures: When to Bill and When to […]
Visits in the Maternity Package
Question: How many visits are included in the payment for the maternity care package? Answer: The global maternity package includes approximately 13 routine antepartum visits for an uncomplicated pregnancy: monthly visits up to 28 weeks, biweekly visits to 36 weeks, and weekly visits until delivery. Fewer than four prenatal visits do not qualify for global reimbursement and […]
Coding Guide – Maternity Services
This guide addresses CPT® coding for maternity care services. It covers coding for professional services performed by physicians and other qualified health care professionals including Certified Nurse Midwives in obstetrics, family medicine, and maternal-fetal medicine. It describes how to code for global maternity care, antepartum care only, delivery services only, postpartum care only, and itemized […]
Reporting the Global Surgical Package | Webinar
Recorded October 16th, 2025
1 CEU expires 10/30/26
The global surgical package provides a single payment for services normally performed before, during and after a procedure. This webinar will review both CPT® and CMS rules and explain what services are included in the payment and what services may be reported separately.
Problematic Modifiers – 22, -52, -58, -78, -79 | Webinar
Recorded June 19th, 2025
1 CEU expires 6/30/26
Guest presenter Shannon McCall of HCPro
This webinar focuses on selected CPT® modifiers that tend to be problematic for coders and claims processing, with emphasis on the application of modifier-22 and -52 including commonalities and differences as stated by the AMA and supportive citations from the Medicare Claims Processing Manual.
Can I Get Paid For…Removal of Sutures or Staples
In 2023, CPT® deleted code 15850 and revised code 15851. Prior to then, these codes differentiated between suture removal by the same surgeon who performed the primary procedure and suture removal performed by a different surgeon. It also used the term “under anesthesia other than local.” In CPT Changes 2023 An Insider’s View, the AMA said that […]
Coding Multiple Procedures | Examples with Modifiers
Biopsies and lesion destruction codes are often performed at the same patient visit. This leads to questions about bundling and modifiers. There are two steps to billing these correctly and avoiding denials: Check the total RVU values Check the NCCI edits. There is a step-by-step procedure for coding multiple procedures at the end of this […]
Coding for Mohs Micrographic Surgery
Mohs surgery is performed to remove complex or ill-defined skin cancer, and the procedure includes both the surgery and histopathologic examination. Both capacities are required in order to bill for these codes, and neither part may be delegated to another individual. Let’s look at the specific guidelines for coding for Mohs Micrographic Surgery: According to […]
Shaving of Epidermal or Dermal Lesions
The chart below includes CPT® codes, and descriptions for shaving epidermal and dermal lesions. After the chart, there are important key points to keep in mind when using these codes. Code Description 11300 Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less 11301 lesion diameter […]
Modifier 51 or 59? How to Know Which to Bill?
Modifier 51 and 59 are both used on second and subsequent surgical procedures, when performed on the day of a primary procedure See also Modifier 59 quick reference sheet There are two modifiers commonly used in surgical specialties when billing two or more procedures at the same encounter. Appending the correct modifier increases the likelihood […]
Coding for Destruction of Malignant Lesions
The primary factors in selecting a code for destruction of malignant lesions are: Selectd by size of lesion (not defect) Location Method is not a factor in code selection Report a code for each lesion treated Per Principles of CPT® Coding: “The destruction of malignant lesions is reported with codes 17260—17286. Similar to the codes […]
CPT® Codes for Fine Needle Aspiration
Fine needle aspiration biopsy Material is aspirated with a fine needle and the cells are examined cytologically. A core needle biopsy is performed with a larger bore needle to obtain a core sample. Use code 10021 for FNA without imaging guidance, first lesion and 10004 for each additional lesions. Use codes 10005 – 10012 for […]
Skin Biopsies
Correctly selecting and reporting skin biopsies requires an understanding of CPT® codes for skin biopsies There are codes for excision of benign and malignant lesions, and codes for shave procedures. Those are coded based on the size of the excision and location There are specific biopsy codes in other chapters, for biopsy of ears, lips, […]
Coding Guide – Minor Surgical Procedures
This guide includes definitions of minor procedures used frequently in primary care and urgent care. And, even more important, instructions for billing the services. No minor procedure guide would be complete without a discussion of modifier 25. It is also the reference for CodingIntel’s minor procedures webinar which you can watch here.
What Does the Decision to Perform a Minor Procedure Really Mean?
This article is updated with CPT’s March 2023 document, “Reporting CPT® Modifier 25.” (citation at the end of the article). That CPT® article adds specificity to what is included in typical pre and post work, which will make it more difficult to report both a procedure and an E/M service for some encounters. According to […]
Selecting CPT® Rules for Excision of Skin Lesions
Many medical practices perform skin procedures. A patient may see a dermatologist, a family physician or a surgeon when the time comes to find out, “What’s this thing growing on my arm?” This article discusses excision of benign and malignant lesions. Shaves, biopsies, and destruction of lesions are covered in other articles. Per CPT, excision […]