262016Apr

Tympanostomy Tube with Intratympanic Injection

April 28, 2016 Question: I did an intratympanic steroid injection and coded 69801 and 69433. Medicare paid 69801. Should I appeal the denial of 69433? Answer: No! CPT 69801 says Labyrinthotomy, with perfusion of vestibuloactive drug(s); transcanal. The CPT guidelines say: Do not report 69801 in conjunction with 69420, 69421, 69433, 69436 when performed on the same ear. By…

132016Apr

Placement of Doyle Splints

April 14, 2016 Question: My doctor documents placement of Doyle splints in the nose which are sutured to the anterior septum after a septoplasty. Can I bill 31299 for this? Answer: No, placement of intranasal splints, dressings and packing is part of the wound closure and not separately reported. *This response is based on the best information available as…

312016Mar

New or Existing Patient Coding

March 31, 2016 Question: If I see a new patient (9920x) for an ear problem, then they come back to see me for chronic sinusitis a year later, can I bill as a new patient visit (9920x) the second time or is it an established patient (9921x)? Answer: No, this would be an established patient (99211–99215). If you or another otolaryngologist…

172016Mar

Use of Tissue Adhesive for Laceration Repair

March 17, 2016 Question: Does use of a tissue adhesive “count” as a layer for the laceration repair codes? Answer: Actually, yes it does! The CPT guidelines state “Use the codes in this section to designate wound closure utilizing sutures, staples, or tissue adhesives (e.g., 2-cyanoacrylate), either singly or in combination with each other, or in combination with…

32016Mar

Modifier 25 and Audiograms

March 3, 2016 Question: When I bill an E/M code such as, a new patient or established patient visit, do I need to append modifier 25 when I also bill for an audiogram? Answer: No, not for Medicare claims. Modifier 25 is appended to the E/M code to show your service is above and beyond that which is included in…

182016Feb

Cerumen Removal vs. E/M Code

February 18, 2016 Question: Someone told me to bill an E/M code like 99212 or 99202, instead of 69210 when removing impacted cerumen with instrumentation. What do you think? Answer: Absolutely not! The ICD-10-CM code for cerumen impaction (H61.20 – H62.23) supports reporting a CPT code for the removal (69210). Also, Medicare’s payment for 69210 is higher than…

22016Feb

Excision of Skin Lesion

February 2, 2016 Question: I heard you say at a course (you were great, by the way, I learned a lot from you!) that we should wait for a pathology report before billing for excision of skin lesions.  Please explain why.  This may be why I’m not getting paid. Also, when is your next ENT coding course? Answer: Thank you for…

142016Jan

Repair of Nasal Vestibular Stenosis

January 14, 2016 Question: I am trying to come up with the right CPT codes for a repair of nasal vestibular stenosis so we can get it pre-certified. Can you help? Answer: Yes, you are wise to determine the correct codes for pre-certification, otherwise the surgery might not be paid if you billed different codes.  Look at 30465 –…

172015Dec

Cerumen Removal

December 17, 2015 Question: I was in attendance at the “top ten coding issues” talk that you gave in Dallas at the AAOHNS annual meeting.  Great talk, Kim! We spoke regarding CPT 69210 after the session. I just want to confirm that use of magnification is not necessary for this code. My associates insist that 69210 requires using…

32015Dec

Endoscopic Skull Base Surgery

12/03/15 Question: We are thinking about starting an endoscopic skull base surgery program and doing skull base procedures via an expanded endonasal/endoscopic approach. I’ve looked in the CPT book for codes and it looks like CPT 61580–61619 are just what I’m looking for. Is this correct? Answer: That’s great that you’re starting a new program! And,…

52015Nov

Cerumen Removal….Again

November 5, 2015 Question:   I just wanted to verify the guidelines for billing cerumen removal (69210). Before, it needed to state that the cerumen was “impacted” to be able to bill CPT 69210. I was just told that guideline has changed and that anything that goes in the body (I’m thinking like a curette to remove cerumen), even…

242015Sep

ICD-10-CM for Otitis Media

September 24, 2015 Question:   I am hoping that ICD-10-CM has codes for recurrent acute otitis media since this is one of the most common reasons why we put in tympanostomy tubes. Did this happen? Answer: Yes – someone must have heard you! Many of the otitis media codes now specify acute, acute recurrent, and chronic. Laterality…

102015Sep

ICD-10-CM for Bilateral Cerumen Impactions

September 10, 2015 Question:   I noticed that the ICD-10 codes for many ear conditions are specific for right, left and bilateral. But what if I am billing for a bilateral procedure, such as tympanostomy tubes? Should I use the right and left codes, or should I use the bilateral code? Answer: Good question! If a bilateral code exists and the disorder…

132015Aug

Holding Claims for Path Reports

August 13, 2015 Question:   Do you advise that we hold our claims for excision of skin lesion procedures until after the pathology report is received? That seems to delay our charges and I want to get them billed quickly! Answer: Yes, you need to hold the claim for the excision of skin lesion codes (114xx for benign…

302015Jul

Lipoma Removal

July 30, 2015 Question:   I removed a huge lipoma from a patient and it seems like the benign skin lesion removal codes just don’t describe what I’m doing. Is there another code I can use? Answer: Yes! The “soft tissue tumor” codes were introduced into CPT in 2010 and better describe the procedure you are performing. These codes are…

162015Jul

Diagnosis Code

July 16, 2015 Question:   I do a lot of reconstruction procedures after the Mohs surgeon has removed the skin cancer. I am not removing cancer so it doesn’t seem right to use a cancer diagnosis code. But what diagnosis code should I use? Answer: We recommend using an “open wound” diagnosis code since the purpose of your procedure is to…

22015Jul

Nasal Sinal Displacement Therapy

July 2, 2015 Question:   After bilateral endoscopic sinus surgery is completed, my doctor documents “the patient then underwent bilateral nasal sinal displacement therapy and all bloody secretions and mucoid secretions were clear.” He wants to bill 30210–50 (Displacement therapy (Proetz type)) in addition to the endoscopic sinus surgery codes. Is that acceptable? Answer: No. Irrigation of…

112015Jun

Harvest of Abdominal Fat Graft

June 11, 2015 Question:   My doctor harvested abdominal fat that he then used in the nose to close the area when he did an endoscopic removal of a pituitary tumor (62165). I want to bill 15770 but my doctor thinks the correct code is 20926. What do you recommend? Answer: Your doctor is correct with 20926 (Tissue grafts,…

212015May

Paramedian Forehead Flap After Mohs Surgery

May 21, 2015 Question:   I did a paramedian forehead flap after the Mohs surgeon removed the cancerous lesion from the nose. What is the CPT code for this procedure and do I need a modifier because I’m in the Mohs surgeon’s global period? Answer: The code is 15731 (Forehead flap with preservation of vascular pedicle (e.g., axial pattern flap,…

72015May

Repair of Nasal Vestibular Stenosis

May 7, 2015 Question:   I will sometimes do a septoplasty with the repair of nasal vestibular stenosis. Is it OK to bill both codes together? Answer: Yes, it sure is assuming the documentation supports both separate services. CPT 30520 (septoplasty) is not included in the code for nasal vestibular stenosis repair (30465, Repair of nasal vestibular stenosis…

232015Apr

ICD-10: Procedural Coding System vs. CPT Codes

April 23, 2015 Question:   Now that ICD-10 is going to happen I’m starting to look into it a bit more. I see there is a procedural coding system component. Are we going to have to use that instead of, or in addition to, CPT? Answer: Good question. The ICD-10 procedural coding system (ICD-10-PCS) is used by facilities (e.g., hospital) to…

92015Apr

CPT 92547: Use of Electrodes

April 9, 2015 Question:   What happened? I used to bill 92547 – use of electrodes during electronystagmography – with 5 units and now Medicare will pay only one unit. Answer: Yes, this changed as of 1/1/15 as Medicare’s MUE (medically unlikely edits) now allow payment for only 1 unit.

122015Mar

Changes to CPT Esophagoscopy Definition in 2015

March 12, 2015 Question:   I did a direct laryngoscopy, bronchoscopy and esophagoscopy for tumor staging. Are all three codes billable? Answer: Yes, but make sure that you performed what CPT now says is included in the esophagoscopy. Effective 1/1/15, CPT added this guideline: “Esophagoscopy includes examination from the cricopharyngeus muscle (upper esophageal sphincter) to and including the…

262015Feb

Intraoperative Monitoring

February 26, 2015 Question:   I would like to know the codes I can bill for neural monitoring during a thyroidectomy, mastoidectomy, and parotidectomy cases. Answer: Intraoperative neural monitoring is included in the global surgical package for the surgical procedure code(s) billed by the surgeon; therefore, the surgeon would not bill for this service. Placing the needles for intraoperative…

52015Feb

Measuring Square Centimeters

February 5, 2015 Question:   I’m confused about how to determine the square centimeters for using the Adjacent Tissue Transfer codes (14000–14302). Can you explain it in terms that I will understand? I’m not a doctor. Answer: I will certainly try! The adjacent tissue transfer codes are used when there is a primary defect that results from the excision and…

222015Jan

Ear Canal Debridement…Again

January 22, 2015 Question:   What CPT code would I use for a debridement of purulent debris from the ear canal, with or without placement of a wick in, such as when the patient has Swimmer’s ear? One of my colleagues told me he bills cerumen removal (69210) because there is always a little bit of cerumen mixed in the debris….

82015Jan

Weekend Rounds (Part 2)

January 8, 2015 Question:   Thanks for answering my question last time – I get it now that I would not charge for rounding on post-op patients of my call partners. What about non-surgical patients? Can I bill for making rounds? Answer: Yes, absolutely! As I said, you should treat the patient as if it were your own. So you would…

232014Dec

Weekend Rounds

December 23, 2014 Question:   I have just a quick question regarding weekend rounding. I share weekend call with another practice that I am not affiliated with. Sometimes, when rounding, I check on 5–10 of their patients, some of which are their post-ops and some have not had surgery. Since I am not part of their practice, is this something I can bill…

112014Dec

UPPP & Tonsillectomy

December 11, 2014 Question:   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. Answer: That’s a very good question. From a CPT coding standpoint, the tonsillectomy code may be separately reported from the UPPP. Here…

252014Nov

Billing Sinus Lavage with Sinuplasty Procedures

November 25, 2014 Question:   We listened to a webinar the other day where the coding consultant said it was OK to bill a sinus lavage code such as 31000 (Lavage by cannulation; maxillary sinus (antrum puncture or natural ostium)) or 31002 (sphenoid sinus) with the endoscopic sinus balloon dilation codes. This doesn’t seem right. What do you think? Answer:…

132014Nov

Billing an Injection Given by a Nurse

November 13, 2014 Question:   Dr. A ordered a Rocephin injection on a patient but he was not in the office when the nurse gave the injection. We billed the injection under Dr. A’s name and NPI because it was his patient. Does Dr. A have to be in office for us to bill the injection or is it ok if…

302014Oct

Videostroboscopy/Flexible Fiberoptic Laryngoscopy

October 30, 2014 Question:   I recently purchased a videostroboscopy for my practice and was talking to the rep about how to bill for the service. The rep told me to bill 31575 for the flexible fiberoptic laryngoscopy and also 31579 for the videostroboscopy. I’ve billed both codes a couple of times but we can’t seem to get paid…

162014Oct

ICD-10 “X” Placeholder

October 16, 2014 Question:   I recently listened to a webinar on ICD-10. They discussed the x placeholder, but I still don’t understand exactly when to use it. Can you help explain? Answer: Absolutely we can help! The “X” placeholder has two functions in ICD-10-CM. First, it is used with some codes as a placeholder for future code expansion. It holds…

22014Oct

7th Character Extension in ICD-10

October 2, 2014 Question:   Our practice sees a fair number of patients with a diagnosis of “open wounds”. I was looking at these codes in ICD-10 and noticed a character needs to be added to say whether the encounter is initial or subsequent. Is the first visit with the doctor always A for initial and the follow up visits always D for…

182014Sep

Different Procedures, Different Ears

September 18, 2014 Question:   One of our doctors did a tympanoplasty on the right ear and a paper patch on the left ear. These codes are bundled. Can I be paid for both procedures? If so, how do I code this? Answer: While these codes are bundled, you are right that you should be paid for both procedures in this…

42014Sep

Drainage of a Postoperative Seroma

September 4, 2014 Question:   We had a patient come into the office for their postop check after a thyroidectomy and neck dissection. The doctor ended up having to drain a seroma. I sent the claim into Medicare with a 78 modifier, but it was denied as included. Did I use the wrong modifier? Answer: Payment for complications in the global period will…

212014Aug

Orders for Audiology Testing

August 21, 2014 Question:   Someone just told me that we need to have an order on the chart for audiology testing. Is this true? Answer: Yes, Medicare requires an order from a physician or non-physician practitioner (NPP), such as a Physician Assistant or Nurse Practitioner, to bill and be reimbursed for audiologic diagnostic testing services. These services are not…

72014Aug

Billing for an Audiologist

August 7, 2014 Question:   Can we bill our audiologist’s services under the physician’s name and NPI? Answer: It depends on the payer. Medicare requires, and has since 2008, audiologists to be credentialed and bill under their own NPI (National Provider Identifier) for any services personally performed. Thus, any services personally performed by an audiologist cannot be billed…

242014Jul

Adjacent Tissue Transfers

July 24, 2014 Question:   If my doctor does more than one adjacent tissue transfer, do I add them together and bill one code or do I bill them separately? Answer: No, you do not add them together and bill one code. The adjacent tissue transfer (ATT) or rearrangement CPT codes 14000–14302 are reported per defect. Therefore, you will…

102014Jul

Submucous Resection of the Inferior Turbinates

July 10, 2014 Question:   My physician and I disagree about the correct use of CPT code 30140 SMR of inferior turbinates. I have told him that he needs to document removal of bone, but he doesn’t agree and hasn’t been documenting this. Please help! Answer: You both are correct! In the submucous resection of the inferior turbinate (SMR)…

262014Jun

Tonsillectomy with UPPP

June 26, 2014 Question:   Is it OK to bill for tonsillectomy and a UPPP separately? Most of the payers deny this as a bundled service when the two codes are submitted together. Answer: Yes, per the AMA’s CPT coding guidelines and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), these are separate and distinct procedures that can be coded…

122014Jun

Nasal Septal Graft Bundling

June 12, 2014 Question:  My physician did a septoplasty and also harvested a graft from the septum for repair of nasal vestibular stenosis. I billed CPT 30465 (nasal vestibular stenosis repair), 30520 (septoplasty) and 20912 for the septal graft. Insurance denied the graft code as bundled. I tried to appeal this and was denied. Shouldn’t this be paid because the…

292014May

Sub-Specialty Otolaryngologists

May 29, 2014 Question:   I am new to credentialing at my clinic. We have 3 ENT doctors and a new physician joining the practice in the next few months. The new physician is a Pediatric Otolaryngologist. I am starting the initial paperwork, but can’t find a specialty code for Pediatric Otolaryngology. Should I credential him under Pediatrics? Also, since he is a different…

152014May

Removal Of Nasal Pack

May 15, 2014 Question: A patient came to the office after being seen in the emergency room with a nasal pack in place. I removed the nasal pack, but can’t figure out how to bill for taking it out. The nasal control codes only seem to be for placement. Answer: There isn’t a code for just removal of a nasal…

12014May

Suture Removal

May 1, 2014 Question:   We had a patient come into our office to have their sutures removed from a facial laceration repaired by someone else. The patient was hurt while on vacation and couldn’t have the sutures removed while away. The problem is the patient is still in the global period from the repair performed by another physician….

172014Apr

Medication Refills

April 17, 2014 Question:   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…

32014Apr

Cerumen Removal 2014

April 3, 2014 Question:   I noticed that I am getting denials from Medicare when I use modifier 50, bilateral procedure on 69210. I thought we were allowed to bill with modifier 50 as of January 1, 2014. What should I do? Answer: This has been an ongoing issue since the code 69210 was revised effective January 1, 2014. Some payors…

62014Mar

Excision of a Skin Lesion

March 6, 2014 Question:   When coding for excision of a skin lesion (114xx, 116xx), do I use the size on the pathology report to determine the correct CPT code? Answer: The most accurate measurement, according to CPT, is when the lesion has not yet been excised and is still on the patient. The specimen reduces in size when it…

202014Feb

Postop Mastoid Debridement

February 20, 2014 Question:   My doctor did a mastoidectomy on a patient. Can we bill for the mastoid debridement using 69220 when the patient comes back to the office for a postop debridement? Answer: The mastoidectomy codes (e.g., 69641–69646) have a 90-day postoperative global period and include all postoperative care related to the mastoidectomy procedure. Therefore, the postop office debridement…

62014Feb

Debridement of Ear Canal

February 6, 2014 Question:   We billed 11000 (Debridement of extensive eczematous or infected skin; up to 10% of body surface) for debridement of an ear canal with a diagnosis code of otitis externa (380.23). The payor denied 11000 and say there was no “medical necessity” documented. I don’t get it. Please help. Answer: The denial occurred because 11000…

232014Jan

Stand-by Services

January 23, 2014 Question:   What is the right code and way to document a stand by tracheostomy? Here’s a clinical scenario… 70 y/o woman comes in to the ER with tongue swelling, she has respiratory distress needs intubation. I get called in to stand by while the anesthesiologist performs an intubation. I will need to perform a tracheostomy if the intubation…

262013Dec

Intraoperative Monitoring

Question:   OK, so I now realize that I should not be billing for intraoperative monitoring based on the CPT changes for 2013. The consultants at KZA have been saying this for years and I’m now on board with you. My question is: Can I at least bill the codes 95867 or 95868 for the surgeon at the time…

262013Nov

Intraoperative Monitoring

Question:   When performing a thyroidectomy or parathyroidectomy, and a physician’s assistant is assisting, can the PA bill for the nerve monitoring codes, 95867, 95868, +95940? Answer: No, neither the surgeon or an assistant surgeon or even a co-surgeon may bill for intraoperative nerve monitoring.

142013Nov

VEMP

Question:   Our audiologist is doing this new test called VEMP? The equipment vendor gave me a big long list of codes to bill for this test including the ENG, EMG and other diagnostic testing codes. It just doesn’t seem right. What is your advice? Answer: We agree that billing ENG and EMG codes isn’t accurate for…

312013Oct

Nasal Endoscopy

Question:   I did a nasal endoscopy (31231) and adenoidectomy (42830) on a young child. The insurance company denied the nasal endoscopy but paid on the adenoidectomy. I wouldn’t think these two codes are bundled. What do you think? Answer: To answer your question, we requested the operative report from you to see what the documentation says. Your note lists…

172013Oct

PQRS Reporting Requirement In 2013

Question:   I have not participated in Medicare’s Physician Quality Reporting System yet. I just heard that my Medicare payments will be reduced if I don’t participate. What do you suggest I do? Answer: You are correct – Medicare will reduce your 2015 payments if you do not participate in PQRS in 2013. The minimum participation is to submit…

32013Oct

A Letter From a Private Payor About My E & M Coding. Should I Be Concerned?

Question:   I received a letter from a private payor saying I report a higher percentage of 99204, 99205, 99244 and 99245 services than my peers. The letter advised me to review the E & M requirements for these codes. Should I be concerned? Answer: Yes you should! This is essentially a warning letter that your payor is trending your E&M services and…

52013Sep

Skin Lesion Removal and Closure

Question:   I have a question on lesion removal and closure coding. If two lesions the same size, same diagnosis (e.g., malignant) and same area (e.g., neck) are removed, is the code used twice or are the sizes added together for one code? I have the same question for a repair- same site (per code description), same type of…

222013Aug

ER Discharge

Question:   Our surgeon was called to the Emergency Room to see a patient in consultation. The patient was discharged from the Emergency Room. Can you tell us how to report this? Answer: The correct category of CPT code will be dependent on payor rules. According to the 2013 AMA CPT rules, the service is a consultation and…

82013Aug

Endoscopic Sinus Debridements: Reportable or Not?

Question:   Is appropriate to bill 31237–79 at the 1 week post op for our sinus surgery patients? I can’t help but feel that service would be included in the septoplasty or the turbinate surgery performed at the same session. The physician and office manager it should be billed when performed during the global period, but I just can’t…

252013Jul

Calculating Size for Codes

Question:   I’m new to coding. My doctor and I have a disagreement on how to calculate the size for the adjacent tissue transfer codes (140xxx). The doctor says there was a 16.5 cm by 7 cm wound that he did an adjacent tissue transfer to close. I think I should use a code for a 23.5 square centimeter code because 16.5 plus 7 equals…

112013Jul

Intraoperative Angiography During Microvascular Flap Surgery

Question:   I am doing this new thing during my microvascular free flap procedures where I do intraoperative fluorescent angiography (Spy) to evaluate tissue perfusion prior to closing the wound. I’m told I can bill CPT 15860 intravenous injection of agent (e.g., fluorescein) for this in addition to the microvascular free flap code. I’ve tried billing it the…

272013Jun

Inferior Turbinate Submucous Resection and Outfracture

Question:   I did an inferior turbinate submucous resection removing subcutaneous tissue and bone followed by out-fracturing with the Boise elevator. Can I bill 30140 for the submucous resection and 30930 for the out-fracture? Answer: Actually, CPT specifically says “Do not report 30801, 30802, 30930 in conjunction with 30130 or 30140.” Therefore, it would not be appropriate…

132013Jun

Intraoperative Laryngeal Nerve Monitoring

Question:   Can I bill for intraoperative laryngeal nerve monitoring when I am doing procedures such as a parathyroidectomy or thyroidectomy? Answer: No, intraoperative monitoring is not separately billable for the surgeon. Intraoperative monitoring has always been included in the global surgical package for surgeon and CPT now actually documents this in the CPT 2013 manual.

302013May

Endoscopic Concha Bullosa Resection with Other Sinus Procedures

Question:   I did endoscopic sinus surgery (maxillary antrostomies and anterior ethmoidectomies) as well as endoscopic bilateral resection of concha bullosa. I told my biller to submit the following codes for me: 31254–50, 31256–50, 31240–50. My biller says the concha bullosa resection code is “bundled” into the other codes and she won’t submit the codes. I say it…

162013May

How Do I Calculate The Size of An Adjacent Tissue Transfer Code

Question:   I am inquiring how to calculate the size of a wound to determine which adjacent tissue transfer code should be reported. The surgeon excised a dematofibrosarcoma protuberans of the chest that resulted in a primary and secondary defect documented as a 16.5 x 7. The secondary defect was closed primarily. My surgeon says the size of the defect is…

22013May

Maxillary Sinus Lavage (31000)

Question:   My doctors want to bill 31000 for a maxillary sinus lavage every time they do an endoscopic procedure on the maxillary sinus such as 31256 (endoscopic maxillary antrostomy), 31267 (endoscopic maxillary antrostomy with tissue removal from within the sinus) and 31295 (endoscopic balloon dilation of the maxillary sinus). The lavage is bundled with 31256 and…

182013Apr

Thyroidectomy with Central Neck Dissection

Question:   How do I code a thyroidectomy for malignancy with bilateral central neck dissections? I see 60252 for Thyroidectomy, total or subtotal for malignancy; with limited neck dissection but not bilateral central neck dissections. Answer: Actually the central neck is not considered to be a structure that has laterality to it – central is middle. So if you are…

42013Apr

Direct Laryngoscopy with Multiple Biopsies

Question:   I did 31535 Laryngoscopy, direct, operative, with biopsy but took multiple biopsies through the laryngoscope of the hypopharynx and base of tongue looking for an unknown primary malignancy. Can I report 31535 more than once to account for the multiple biopsies? Can I bill 42802 (Biopsy; hypopharynx) with the direct laryngoscopy? Lastly, what if I did a separate…

212013Mar

Modifier 25

Question:   Do we have to append modifier 25 to the E&M code if only an audiogram were also performed at that same visit? Or does modifier 25 not apply since the audiogram is a diagnostic test? What about when we do an in-office CT on the same day as an office visit – should we append…

72013Mar

Nasal Fracture Repair vs. Rhinoplasty

Question:   I did an open treatment of a nasal fracture repair and septoplasty on a patient who was in a bar fight two years ago on spring break and had his nose broken. He now has nasal airway obstruction and deviated nasal septum as well as displaced nasal bones. I billed 21335 (Open treatment of nasal fracture; with concomitant…

212013Feb

Endoscopic Zenker’s Diverticulectomy

Question:   I can’t find a code for this procedure. I found 43130 (Diverticulectomy of hypopharynx or esophagus, with or without myotomy; cervical approach) but it doesn’t say endoscopic so I’m not sure if I should use it. Answer: You are right to be cautious! CPT 43130 requires a skin incision so it should not be used for an endoscopic, or…

72013Feb

Botox of the Parotid Gland

Question:   What is the code for injection of Botox the parotid for hyperhidrosis or to control excessive oral secretions? Answer: The code you are looking for is 64611 (Chemodenervation of parotid and submandibular salivary glands, bilateral). The code assumes you are doing at least four injections: right parotid, right submandibular, left parotid and left submandibular)….

242013Jan

MSL with Lysis of Stenosis and Steroid Injection

Question:   I am going to do a procedure on a patient with tracheolaryngeal stenosis – a microlaryngoscopy with lysis of the stenosis using a laser and excision of granulation tissue followed by a steroid injection. I gave my surgery scheduler two CPT codes to precertify: 31541 and 31571. She is telling me that I can’t bill these two codes together. Can you…

102013Jan

Myringoplasty and Cartilage Graft

Question:   I have a question regarding the correct coding of a myringoplasty with cartilage graft patch. Is the correct coding for this case: 21235-RT and 69620–51? Answer: CPT 69620 (Myringoplasty (surgery confined to drumhead and donor area)) specifically states that the code includes the “donor area.” Therefore it is not appropriate to report a separate code for the…

272012Dec

Ear Canal Debridement

Question:   What CPT code would I use for a debridement of purulent debris from, with or without placement of a wick in, the ear canal such as when the patient has Swimmer’s ear? Answer: There is no CPT code for this activity and it would be considered part of the E&M code for your service that day. However,…

132012Dec

Allergy Injection Supervision Requirements

Question:   Does the physician have to be in the building when giving an allergy injection? Or can the allergy injection be supervised by physician assistant? Answer: Medicare’s physician supervision guidelines for incident to billing require the billing provider to be physically present in the office suite whether it is a physician or physician assistant (or even…

292012Nov

Removal of Nasal Pack

Question:   The emergency room physician put an anterior nasal pack in a patient and instructed him to see me the next day because I was the ENT physician on call. I saw the patient and removed the pack. I can’t find a CPT code for pack removal – what do I bill? Answer: You’re right, there is no CPT code for…

152012Nov

Allergy Injection

Question:   We have a patient that brings in her own allergy immunotherapy serum that another doctor mixed for her and we just give her the injection. We are told to bill 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular) for the injection. Is that correct? Answer: Actually, you would report 95115…

12012Nov

Myringoplasty and Fat Graft

Question:   Can we bill 15770 with 69620 for a myringoplasty with fat graft? Answer: First, CPT describes 15770 as Graft, derma-fat-fascia meaning it is a graft that includes three layers of tissue. The procedure you describe says “fat graft” so 15770 is not accurate since fat is only one layer of tissue. CPT 69620 states Myringoplasty (surgery confined…

182012Oct

New or Established Patient

Question:   I am new to Otolaryngology. I am in a practice that employs a neuro-otologist and a rhinologist in addition to general otolaryngologists. Do the new patient rules apply to each of these specialties? For example, a patient is first seen by the general otolaryngologist and then is sent to the neuro otologist. Can the neuro-otologist bill a new patient visit…

42012Oct

Le Fort Fractures

Question:   I performed open reduction internal fixation of bilateral Le Fort II fractures through multiple approaches. Would this be coded as 21347–50? Otherwise asked, does 21347 constitute a repair of a unilateral Le Fort fracture? Answer: The Le Fort fracture repair codes should not be reported with the bilateral modifier (50). A Le Fort fracture is inherently bilateral;…

202012Sep

Removal of Tube in Office

Question:   How do I code for the removal of ventilation tubes when performed in the office setting? Answer: There is no separate CPT code for this activity so it is part of your E&M service. It is not appropriate to report 69200 (Removal foreign body from external auditory canal; without general anesthesia) or 69424 (Ventilating tube…

62012Sep

Tonsils / UPPP Revisited

Question:   I was recently speaking to a colleague about reporting CPT codes 42826 and 42145 together when both a tonsillectomy and UPPP are performed. My colleague said they should be reported together when performed but when I looked at the CCI edits they are bundled. I told her that I could not report both codes because of the CCI edit….

232012Aug

30930 and 30140

Question:   Our surgeon wants to report CPT code 30930 every time he does an turbinate outfracture with his submucous resections (30140). I have explained that the outfracture is included but he disagrees. I talked to a peer in another practice and he told me that I can’t report it because there is a CCI edit in place. We code according…

92012Aug

Removal of Tube in Office

Question:   How do I code for the removal of ventilation tubes when performed in the office setting? Answer: There is no separate CPT code for this activity so it is part of your E&M service. It is not appropriate to report 69200 (Removal foreign body from external auditory canal; without general anesthesia) or 69424 (Ventilating tube…

262012Jul

Endoscopic Zenker’s Diverticulum

Question:   How do I code for removal of a Zenker’s diverticulum when the procedure was performed endoscopically? Can I still use 43130 (Diverticulectomy of hypopharynx or esophagus, with or without myotomy; cervical approach)? Answer: There is no code for the endoscopic removal of the Zenker’s diverticulum as 43130 describes an open procedure. You will need to use an…

122012Jul

E&M Visit with Allergy Injection

Question:   Can I bill for both the 99211 and “95117 – Professional services for allergen immunotherapy not including provision of allergenic extracts; 2 or more injections” – codes when the patient comes for their weekly allergy injection? Answer: If the purpose of the visit is to provide the allergy injection then report only the code for the…

282012Jun

Ear Exam Under Anesthesia

Question:   Our surgeon performed an evaluation of the external ear canal on a pediatric patient because the child would not allow the surgeon to evaluate the ears thoroughly in the office. We cannot find a CPT code for this service. Do we use an unlisted code? Answer: The correct way to report this service, assuming a more definitive…

142012Jun

Wound Cultures

Question:   Our surgeon recently took a patient to the OR for an I&D of a neck abscess. The documentation in the operative note indicates a culture was taken. The only CPT codes I can find are in the pathology section. Is this work reportable by the surgeon? Answer: Thanks for your question and one that is not uncommon. The…

312012May

Written Physician Order for Audiologic Evaluations?

Question:   Does Medicare require a written physician order for audiologic evaluations, even if the audiologist is employed by our otolaryngology practice? Answer: Yes. Medicare requires the following in order to file under the NPI of the audiologist for diagnostic audiology procedures, as specified in the Medicare Benefit Policy Manual, Chapter 15: a. The order must be…

32012May

CPT and Diagnosis Codes for a Skin Lesion

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…

292012Mar

Coding Multiple Z-Plasties

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…

152012Mar

Different Procedures / Different Ears

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…

12012Mar

Medicare Supervision Requirements for Audiologists

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…

162012Feb

I&D in the Office During the Global Period

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….

262012Jan

Intranasal Application of Medication

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’…

122012Jan

Endoscopic Polypectomy

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…