The Otolaryngology Coding Coach 2007 Archives

Question: 

We are a new ENT practice and our physician will be placing tympanostomy tubes in the office.  We are receiving conflicting information about billing for the tubes. Some say “yes, bill”, others say “no, don’t bill”.  Can we bill for the tubes in addition to the CPT code for the placement?

Answer: 

The tympanostomy tubes themselves, as a supply, are not separately reportable as they are considered an integral part of the procedure.  The reimbursement is included in the practice expense of the non facility RVU for the tympanostomy tubes.

Question:

If a surgeon performs a myringoplasty, can the harvesting of a tissue graft be reported in addition to the myringoplasty?

Answer: 

No, the CPT code for the myringoplasty, 69620 Myringoplasty (surgery confined to drumhead and donor area) states that the surgery includes the drumhead and the donor area, thus the harvesting of the graft is not separately reportable.

Question:

Our surgeon repaired a simple laceration with Dermabond on a Medicare patient.  I thought there was a code we could use to report this service, but I cannot find one. Can you help?

Answer:

Medicare has defined HCPCS code G0168 Wound Closure Utilizing Tissue Adhesive(s) as the only appropriate code to define wound repairs using products such as those defined as Dermabond.  Unless there is another problem, you will report using this code only.  You can expect about $27 from your Medicare fiscal intermediary. 

Question:

Can we report E&M services with the allergen immunotherapy CPT codes?

Answer:

According to CPT rules “office visit codes may be used in addition to allergen immunotherapy, if other identifiable services are provided at that time”. If the patient is seen only for the purpose of receiving their injection and there is no significant other E&M services provided, the E&M would not be reported in addition to the allergen immunotherapy codes.

Question:

We have professional staff in our office (RNs) who may perform and document services that support billing the 99211 code. Our question is, if the physician is not in the office, but either the Nurse Practitioner (NP) or Physician Assistant (PA) are in the office, can we bill the RNs work “incident-to” to either the NP or PA who is in the office. These are all established patients.

Answer:

Yes, you may bill the RN’s work “incident-to” the PA or NPs supervision since they are in the office, but the physician is not. Remember, the PA or NP may bill direct or “incident-to”, thus in this scenario the PA/NP would bill under his or her own UPIN/NPI. However, this does not apply to the supervision of diagnostic tests that require direct physician supervision (meaning a physician must be in the office). For more information on diagnostic service that require “direct” physician supervision, refer to the Medicare fee schedule and look for a “2” modifier next to the CPT code.

When submitting the 31237-79 during the global period of the septoplasty, make sure that the septal deviation or airway obstruction is not linked to CPT code 31237 and the specific sinus diagnosis code is linked to CPT code 31237.

Question:

We are using modifier 79 on the debridement codes during the post op period of a septoplasty and are being denied based on diagnosis code. What diagnosis code do you suggest we use?

Answer:

Without more specifics we cannot give you specific advice, but we can direct you back to the original claim on the date of surgery as a start. Review the initial claim and make sure the septoplasty is not linked to a chronic sinusitis code and make sure the ESS codes are not linked to a deviated septum or airway obstruction diagnosis code. Also, make sure a pansinusitis diagnosis code is not linked to the ESS codes.

Question:

Our physician is performing transtympanic membrane injections with aminoglycosides in the office. She will typically give 1-3 injections. How do we report this?

Answer:

The correct CPT code is 69801 Labyrinthotomy, with or without cryosurgery including other nonexcisional destructive procedures or perfusion of vestibuloactive drugs (single or multiple perfusions); transcanal. Notice that the code states single or multiple perfusions and has a 90 day global period. Thus the code is reported for the first injection and then the subsequent injections are included in the global period and reported with CPT code 99024, Post op no charge.

Question:

Our surgeon performed a myringoplasty and took a graft from the patient’s earlobe to patch the perforation. Can we report CPT code 20926, tissue graft in addition to CPT code 69620, the myringoplasty?

Answer:

No, the graft is included in CPT code 69620 Myringoplasty (surgery confined to drumhead and donor area), which by definition includes the graft to close the perforation.

Question:

I keep hearing that we must append modifier 25 to the E&M service when it is performed on the same day as an audiogram. This does not make sense to me as an audiogram is 1) diagnostic and 2) not included as a standard part of an E&M service. Can you help us?

Answer:

Your thought process is correct. This “rumor” dates back to 1999 or 2000 when Medicare inadvertently put a CCI edit in place for multiple diagnostic tests when reported on the same day as an E&M visit. This edit was promptly reversed the following quarter. Unfortunately, this has stayed “out there” and years later some coders still think the modifier 25 is required.

Question:

We have a Medicare patient who presented to the ER with a post op infection during the global period of his surgical procedure. Our physician was called to the ER to see this patient and submitted charges for the I&D he performed in the ER. I am not sure I can report these services. Is this I&D separately reportable or not?

Answer:

No, the service is not separately billable according to Medicare’s definition of the global surgical package. To bill for the treatment of a complication during the global period, the service must be performed in the OR, ASC, endoscopy/laser suite, or ICU if patient is critically ill and is unable to be transported to the OR. The ER, holding area, PAR, non-certified procedure room does not constitute an approved location.

Question:

Our physician performed an “Endoscopic Zenkers Procedure”. I am not sure what this is and cannot find this in the CPT book. How do I code this?

Answer:

You won’t find it because the CPT code is not defined as a Zenkers Diverticulum. There is no endoscopic procedure code for this procedure. Use the unlisted esophagus CPT code, 43289: Unlisted laparoscopy procedure, esophagus.