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The Otolaryngology Coding Coach 2012 Archives
| CPT and Diagnosis Codes for a Skin Lesion |
May 3, 2012
Question:
A patient was sent to us by another provider who had a biopsy proven pathology report showing a basal cell carcinoma. We removed additional margins and the pathology report came back benign for us. We are confused about whether we should report the CPT and diagnosis codes for a malignant or benign lesion since we did not do the original biopsy.
Answer:
This is a very good question! Because you have a previous positive pathology report, even though it is from a different physician, then you may report your procedure using the excision of malignant lesion CPT code (e.g., 116xx) and a malignant skin neoplasm diagnosis code. |
| Selective Debridement of the Skin - How is it coded? |
April 12, 2012
Question:
The debridement codes for skin, 11040 and 11041 are no longer in the CPT book. Does that mean debridement of the skin is no longer billable?
Answer:
The selective debridement codes were revised in 2011. CPT 11040 and 11041, previously used for debridement of partial and full thickness skin respectively, have been deleted. To report selective debridement of the skin, use 97597 and 97598.
New descriptions of the other debridement codes advise reporting 11042 for debridement of subcutaneous tissue, 11043 for muscle and/or fascia, and 11044 for bone. Also new in 2011, these codes are reported by size of debridement and have add-on codes for additional square centimeters debrided. Refer to the CPT Manual for a complete description of the appropriate use of these new/revised codes. |
| Coding Multiple Z-Plasties |
March 29, 2012
Question:
When billing for multiple Z-plasties, is the billing done by the number of Z-plasties or the total sq cm having added together each of the Z-plasty areas in sq cm?
Answer:
The coding for a Z-plasty (140xx codes) is done based on the total sq cm of the primary and secondary defect size and not necessarily the number of z-plasties done. So you will report one code for each defect. If there are two separate defects closed with two separate advancement flaps report one 140xx code for each defect – or two codes. |
| Different Procedures / Different Ears |
March 15, 2012
Question:
We did bilateral myringotomy and tubes with removal of left myringotomy with paper patch graft. I know the two codes, 69436 and 69610, can’t be billed together. But can I bill 69436-RT with 69610-LT?
Answer:
Absolutely! We suggest you also include modifier 59 (distinct procedural service) on 69610 as many payors do not recognize the RT (right) and LT (left) modifiers. CPT 69610 has the higher value so it will be reported first (69610-LT and 69436-59, RT). |
| Medicare Supervision Requirements for Audiologists |
March 1, 2012
Question:
We would like to maximize the time the audiologist sees patients in the office when the otolaryngologist is in surgery. Is the physician required to be in the office for the supervision of any procedures when the audiologist is here alone when they see any Medicare patients?
Answer:
No. Per Medicare supervision requirements (CMS MM6447), when performed by an audiologist, the direct supervision requirement is not applicable to diagnostic audiology procedures. The audiologist may see any patient, but remember, the physician referral for a medically necessary reason for Medicare beneficiaries is required. |
| I&D in the Office During the Global Period |
February 16, 2012
Question:
Our surgeon saw a patient in the office for a routine post-op check during the global period of a thyroidectomy. During the visit, the surgeon notes that the patient has some neck fullness and performs an incision and drainage in the office. I have the correct CPT code, but I am wondering if I should use Modifier 58 or 79. I think the correct modifier is modifier 79 because he documents a new diagnosis “chylous effusion”. Do you recommend modifier 58 or 79?
Answer:
The reporting (or not) of this service performed in the office, during the global period
will be payor dependent. If the payor is Medicare, or follows Medicare rules, the visit is not reportable as this a complication of the original surgery.
If the payor follows CPT rules, and the surgeon determines this is not “typical postoperative care” then traditionally no modifiers are appended. Modifier 79 is typically reserved for an ‘unrelated’ procedure/ service at a different location. The chyle leak is secondary to the surgical intervention—thus if there had not been surgery, there would not be a chyle leak. Survey your private payors to determine which modifier, if any, is required. |
| Intranasal Application of Medication |
January 26, 2012
Question:
Our physicians will be starting a new treatment for chronic rhinosinusitis in patients after they have endoscopic sinus surgery and are still symptomatic. As we understand the medication, which is a gel, will be applied in the office under endoscopic visualization to the areas of the sinus mucosa where there inflammation is still present. The physician’ will perform an endoscopic exam and then apply the gel to the sites of inflammation when present.
How do we code for this endoscopic application of the gel?
Answer:
Thanks for your question! We assume you are speaking about the application of Mometasone Furoate gel. There is no code for the endoscopic “application” as the use of the endoscope is the “route” or “vehicle” to administer the drug. The scenario indicates that an endoscopic exam will be performed, thus the use of 31231 appears to be the most appropriate. A definitive CPT code recommendation can only be given once a procedure note is reviewed. |
| Endoscopic Polypectomy |
January 12, 2012
Question:
Can you tell me why CPT 31237 is bundled into the sinus codes? We performed 31237, to remove the nasal polyps, and then 31254 for the endoscopic anterior ethmoidectomy on the same side. The payor denied 31237 as inclusive to 31254 and I don’t know why.
Answer:
The payor is correct – 31237 is indeed included in 31254 (and the other endoscopic surgical sinusotomy codes) when performed on the same side. Removing nasal polyps is considered “access,” or part of the approach, to the sinuses. The value for the endoscopic sinusotomy codes are valued to include removal of nasal polyps so it is considered “double billing” to also report 31237.
Also, note that the CPT descriptor for 31237 includes the parenthetical statement “separate procedure.” This means that 31237 may be reported if it is the only procedure performed in the area but is included in a “larger” procedure performed at the same time in the same area. |
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Find more Questions and Answers in the
Otolaryngology Coding Coach Archives.
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Mary LeGrand,
RN, MA, CCS-P, CPC
Kim Pollock,
RN, MBA, CPC
Coding Resources
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