The complexity of CPT surgery coding can be challenging so the Haugen Auditors submitted a couple of questions to the AMA for response. Those questions were included in the Q&A from the American Medical Association’s 2025 CPT & RBRVS Symposium and are provided here:
1. CPT differentiates open inguinal hernias for preterm infants up to 50 weeks and full-term infants up to six months separately, but there’s no such distinction if performed laparoscopically. Should the two existing laparoscopy codes be used no matter the age or should an unlisted code be used to represent inguinal hernia repairs for infants?
- Correct, for laparoscopic procedures there isn’t an age differentiation so 49650 and 49651 which represent a repair of an initial or recurrent repair. It would not be appropriate to use the unlisted but rather use each one of these for any age group. If this is a neonate, then the appropriate modifiers can be used.
2. To use an intermediate repair code, must the superficial or non-muscle fascia be closed in addition to the skin, and do the layers closed need to be specifically named in the documentation? We often see, “the defect was closed in layers using absorbable sutures for deep subcutaneous tissue and 2-0 vicryl for the skin” – Is this acceptable to code for intermediate repair, or is it considered a simple repair?
- Intermediate closure indeed does require closing a layer of tissue in between skin and deep muscle fascia so that would need to be included in the description of work. It has to be a little bit more than just describing that different layers were closed, but instead actually singling out what the layers were that was closed and what was described is pretty close to being able to describe that, but it just needs to be spelled out that way.
3. What CPT code is used to report a resection of a right vagus nerve schwannoma? Can 64792 be used, or is this only used for peripheral. We realize 64471 is for transection of the cranial nerve, but this was a major neck dissection so doesn’t seem to fit the intent of the procedure.
- The biggest nerve is the cranial nerve but that also becomes a peripheral nerve and is an example of a complex peripheral nerve. The coverings of the nerve in the central nervous system are surrounded by oligodendrocytes and Schwann cells are actually surrounding the peripheral nerves. So, by definition Schwannoma would be reported as a peripheral nerve, so 64790 or 64792 depending on if it had a malignant transformation. The 64771 actually isn’t a tubal resection, either so that’s just a transection or avulsion of the cranial nerve so you would not be using that code.
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