February 10, 2022 Question: If one of our physicians performed a septoplasty and sinus surgery and then the patient comes in the office for a 31237 (endoscopic sinus debridement), would we use a modifier 79 (unrelated procedure in a global period) or 58 (staged/anticipated procedure in a global)? Answer: You’ll use modifier 79. The debridements...
January 27, 2022 Question: In the office, one of our physicians, performed 31296-50 (endoscopic dilation frontal sinus), 31295-50 (endoscopic dilation maxillary sinus) and 69706 (endoscopic eustachian tube dilation). The insurance is paying on the 31296 and 31295 but will not pay on the 69706 because Medicare considers it unbundled. Why is the ear procedure is...
December 30, 2021 Question: What is the code for an open septoplasty? I’m doing extracorporeal work removing the septum and reinserting it. It’s more difficult than a regular intranasal septoplasty, 30520. Answer: There is not a separate code for an open septoplasty – 30520 is all we’ve got. You could append modifier 22 (increased procedural...
December 16, 2021 Question: If a patient has one stable chronic illness and one acute uncomplicated illness without systemic symptoms, can we “up” the level of Problems Addressed to Moderate for a new patient (99202-99205) or established patient (99212-99215)? Answer: No, sorry, unfortunately it doesn’t work that way. The problems are no additive or cumulative. ...
December 2, 2021 Question: We had a patient come in for a mastoid debridement using the microscope. It is ok to bill 69220 for the debridement and 92504 for the microscope? Answer: No, the diagnostic binocular microscopy (92504) is included in the surgical/therapeutic debridement code (69220) and not separately reported. In fact, 92504 is included...
November 11, 2021 Question: We saw a patient in the office for a peritonsillar abscess then sent them to the ED/OR for incision and drainage on the same day. What modifier do I need to use? Answer: You’ll use the appropriate E/M code with modifier 25 because the I&D code, 42700,has a 10-day global period...
October 28, 2021 Question: Is 95940 (NIM – neurophysiologic intraoperative monitoring) separately billable with a total thyroidectomy? Answer: Intraoperative monitoring is not separately billable by the surgeon, per CPT guidelines. *This response is based on the best information available as of 10/28/21.
October 14, 2021 Question: Is there a code for smell testing that incorporates olfactory threshold and identification? Answer: Unfortunately, no. You’ll need to use an unlisted code such as 92700. *This response is based on the best information available as of 10/14/21.
September 30, 2021 Question: My ENT doctor ordered an audiogram to be done by our audiologist. The doctor billed for the audiogram to a non-Medicare payor because the audiologist is not credentialled with that payor. Can my doctor “get credit” for ordering and reviewing the audiogram when he chooses the E/M code level? What happens...
September 16, 2021 Question: One of our doctors saw a patient and billed 31231 (nasal endoscopy). The doctor did not document that a topical vasoconstrictive agent was applied. Does the topical anesthesia need to be applied to bill 31231? If topical anesthesia is required and was not used, would modifier 52 (reduced services) need to...
