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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
Mary LeGrand


December 11, 2014


UPPP & Tonsillectomy


Can you tell me if in fact the tonsillectomy code is bundled into the UPPP code? We are having an argument about that in our office and would appreciate it if you’d weigh in.


That’s a very good question. From a CPT coding standpoint, the tonsillectomy code may be separately reported from the UPPP. Here is a Q&A from the August 1997 CPT Assistant:

At the same surgical session, my physician performed a palato-pharyngoplasty and a tonsillectomy. Can both of these services be reported, or is the tonsillectomy part of the palatopharyngoplasty?

AMA Comment:
From a CPT coding perspective, the tonsillectomy is a separate and distinct procedure. Therefore, if the physician performs a palato-pharyngoplasty and a tonsillectomy, both services would be reported. In this instance, the modifier -51 should be appended to the secondary or additional procedure to indicate that multiple procedures were performed on the same day or at the same surgical session by the same physician.”

While CPT may allow separate reporting of the tonsillectomy code, many payors, including Medicare, bundle payment of the tonsillectomy into the UPPP.


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Plan now to attend attend an AAO-HNSF Sponsored Otolaryngology workshop. Click here for 2015 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

Confused about 2014 changes to the cerumen impaction removal code, 69210? Getting payor denials? We are getting many questions from clients and course attendees. Here are a few of those questions: Can I really bill 69210 with modifier 50? Is the microscope included in 69210 or can I also report 92504? Can I bill an office visit with 69210? We have the answers in this pre-recorded webinar!

AAPC CEU Credit: 1 hour

Length: 60 minutes

Learning Objectives:

  1. Describe the 2014 change to the CPT code for removal of impacted cerumen.
  2. Discuss the use of modifier 50 (bilateral surgery) with CPT 69210.
  3. Describe the necessary provider documentation to support reporting 69210.
  4. State the difference between the ICD-9-CM and ICD-10-CM codes for cerumen impaction.

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 access this webinar through Availty's Learning Center.



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 access this webinar through Availty's Learning Center.


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

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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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