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A practice management consulting and training firm working for and with physicians since 1985

The Otolaryngology Coding Coach

KZA consultants discuss two frequently asked spine coding questions every month. Our coding experts are also available for hourly coding consultations and can provide a customized coding and documentation review for your practice.

The Team
Joy McKusick


April 17, 2014

Medication Refills


The physician I work for will often send patients home with two different samples of medication to try to see which works best for them. When the patient calls back to tell the physician which medication has worked, the physician writes the prescription and sends it into the pharmacy. He has been billing a 99211 for this on the day he calls the prescription in for them. Is this correct?


No, you may not bill an E&M code for writing a prescription without a face-to-face visit. The activity of writing a prescription related to a condition that was evaluated in the office is included in the Evaluation and Management (e/m) code the physician submitted the day he/she saw the patient in the office regardless of when the prescription is written. Per CPT instructions, pre- and post- non-face-to-face work associated with an encounter was included in the calculation of the total work of typical services. So the e/m reported for the face-to-face encounter you had with the patient includes any work associated with the visit that is done prior to or after the patient is seen and should not be reported as a separate service.

Also, CPT 99211 requires a face-to-face visit. Because this communication took place over the phone, it would not be appropriate to charge 99211. There are non-face-to-face codes for telephone services, but these are typically not covered by third-party payors and would be a patient-pay service. Be aware these telephone services codes also have guidelines about when they can be billed. If the phone call results in a decision to see the patient or was a result of an e/m service that was reported in the previous 7 days or during the postoperative period the phone call is included in the work of that e/m or procedure and is not separately reported.


Kick Revenue Into High Gear In 2014

Plan now to attend attend an AAO-HNSF Sponsored Otolaryngology workshop. Click here for 2014 courses dates and locations!

For more information on coding and reimbursement assistance contact the Client Service Team at 312.642.5616 or use the online form found at www.karenzupko.com and click on the “Services” tab.


Webinar: 2014 PQRS Made Easy for Otolaryngologists

Presented by Cheyenne Brinson, MBA, CPA

There is nothing easy about delving through the volumes of information about the PQRS program. At the surface, the program is cumbersome and confusing. KZA consultant Cheyenne Brinson navigates the murky PQRS waters in this focused 25 minute webinar and delivers a roadmap for achieving PQRS tailored specifically for otolaryngology.

Length: 25 minutes

Webinar participants will:

  1. Determine which measures groups or individual measures are applicable for Otolaryngologists to report
  2. Distinguish between a registry method of reporting and claims based reporting
  3. Understand the deadlines for reporting

Cost: $49

Click here to download 2014 PQRS Made Easy for Otolaryngologists.


Webinar: Resolving Cerumen Coding Chaos

Presented by Kim Pollock, RN, MBA, CPC

2014 changes to the cerumen impaction removal code, 69210 are confusing. In this webinar, Kim Pollock will clear up the questions around why you are getting payor denials.

AAPC CEU Credit: 1 hour

Length: 60 minutes

Questions we will answer:

  • Determine which measures groups or individual measures are applicable for orthopaedic surgeons to report
  • Distinguish between a registry method of reporting and claims based reporting
  • Develop a plan to avoid the 2016 penalties

Cost: $99

Click here to download Resolving Cerumen Coding Chaos Webinar.



Webinar: ICD-10-CM for ENT

Presented by Joy McKusick, RHIA

You will acquire a solid understanding of ICD-10 structure and specific insight into what that means to ENTs. Joy will share tips on codes for otitis media, sinusitis, tonsils and adenoiditis, nasal fractures and removal of those pesky foreign bodies.

Click here to download webinar access instructions.




Webinar: Skin In the ICD-10 Game

Presented by Joy McKusick, RHIA

ICD-10 requires significant documentation changes to select and assign diagnosis codes for many skin injuries. This one hour webinar with Joy McKusick will help you learn how to educate providers now on these documentation components and reduce claim submission and payment delays. Learn what documentation elements are required to code for increased specificity supporting medical necessity.

Click here to download webinar access instructions.



Not the question you’re looking for? Check out our archives for past Coding Coach Q&A's.

Coding Management Tools

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KZA's E&M Profile Analyzer

Find more Questions and Answers in the Otolaryngology Coding Coach Archives



E&M Profile Analyzer for

Are You At Risk for an Audit?

Your E&M code usage may flag you as an outlier. KZA's E&M Profile Analyzer for Otolaryngology compares your E&M coding patterns against your specialty's state and national figures using CMS's most recently published database. ASPS has arranged for a special member price of $125.00 for one state's data. Click here to learn more about E&M Profile Analyzer for Otolaryngology.



Coding Resources

Do you have a coding question? KZA experts are available for hourly coding assistance.

Read about how KZA can provide a customized coding evaluation for your practice.

Attend otolaryngology coding courses in a city near you.

Purchase Code-Its! the diagnosis coding helper.

Continue your professional education, access timely information about ENT, and meet colleagues in your specialty across the country. If you aren't a member of AOA, find out the advantages of joining. Go to the AOA web site to request a membership package, or access otolaryngology-specific practice management and coding tips.

Read Member View Point:
Should excision of concha bullosa be reimbursed in addition to that for endoscopic surgery?

Protect your practice from fraud and lost revenue. Paladin software allows practices to audit E&M coding for HCFA compliance.







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