Clip ‘n’ Save   (February 2012) First Release

Confused by Sinus Anatomy? This Diagram Highlights Billable Landmarks
Find out what diagnoses go with what FESS procedures.
Warning: If you can’t keep track of where your surgeon is working, you could overlook separately codeable sinus procedures. To leave no dollars on the table, keep this anatomy sheet with CPT and ICD-9 crosswalk handy.
Trace your otolaryngologist’s work and capture functional endoscopic surgery (FESS) procedures and related nasal and concha bullosa work using this diagram.
Test yourself: Do you [...]

CCI 18.0: Learning These Parathyroidectomy and Wound Edits Is As Easy As 1, 2, 3   (January 2012)

Remember: If a Category III code exists, then you should forgo an unlisted code. You may just be digging in to your 2012 CPT® book, but the Correct Coding Initiative (CCI) has already taken aim at some of the new codes by bundling them into existing codes effective Jan. 1. Background: The CCI released version 18.0 at the end of 2012, revealing 15,530 new active pairs and 6,197 code pair deletions, said Frank D. Cohen, [...]

Scopes: Explore Your Diagnostic Scope Coding Options to Ensure Maximum Pay   (January 2012)

Tip: Make this ‘rigid’ versus ‘flexible’ scope distinction.
Are you relying on 31575 for all your diagnostic scope claims? You could be denying your practice up to $80 per claim, and during these times, you can’t afford to miss a dime. If you can spot these key terms for 31231 or 92511, then you can boost your claim’s bottom line.
The numbers should be on your side if you grasp these scope fundamentals.
Dispel 92511 ‘Loser’ Myth
If [...]

ICD-10: Your ‘Other Anomalies’ Code 748.3 Expands to More Specific ‘Other’ Codes   (January 2012)

Tip: Beware submitting probable diagnoses. If you use 748.3 for all your ‘other’ congenital abnormalities of the trachea and bronchi for conditions not otherwise specified in ICD-9, then you should be prepared to encounter more specific ‘other’ codes in ICD-10. Most of them focus on the anatomical areas.Also referred to as congenital deformities of the upper airway, the current ICD-9 code includes:laryngomalacia – a form of congenital laryngeal stridor characterized by flaccidity of the supraglottic structures; [...]

You Be the Coder: Endoscopic Nosebleed Control   (January 2012)

Question: A patient came into our office with a nosebleed. My otolaryngologist provided epistaxis control using an endoscope. I reported 30901 and 31231. The patient’s payer keeps bundling the nosebleed control into the endoscopy code. Should I appeal this?Illinois SubscriberAnswer: The problem is with your coding, not the payer’s policy. CPT includes a specific code for endoscopic epistaxis control: 31238 (Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage). In this procedure, the otolaryngologist uses an [...]

Reader Question: Is 69205-50 Appropriate?   (January 2012)

Question: An otolaryngologist removes a foreign body from both ears under anesthesia. Should I bill the procedure code bilaterally? New York SubscriberAnswer: To determine whether the code is eligible for bilateral billing, you should look up the foreign-body removal code in the National Physician Fee Schedule Relative Value File. Column “Z” will give you the answer. If the column contains a:0 – the code is not eligible for bilateral billing due to anatomy or the code’s [...]

Reader Question: Find Out Who Can Perform History Element   (January 2012)

Question: My coworker thinks an allergist must take a patient’s history, but I think a nurse can perform this duty. Who’s right?California SubscriberAnswer: Any employee can take the history. In fact, the E/M service documentation guidelines state that ancillary staff may record the review of systems (ROS) and/or past, family, and social history (PFSH). Although nurses often record this information, a front-desk staff member may even perform the function. The allergist or nurse practitioner, however, [...]

Reader Question: Use Modifiers In This Turb-Post-Op OV Scenario   (January 2012)

Question: A patient who is returning for follow-up after unilateral endoscopic maxillary antrostomy with tissue removal and turbinectomy complains of a cough and fever. The otolaryngologist evaluates and manages the problem and also performs endoscopic sinus debridement on the patient. What modifiers do I need to report the encounter?Kentucky SubscriberAnswer: Because the unrelated office visit and a staged debridement (planned staging for the endoscopic maxillary antrostomy) occurred during the turbinectomy’s 90-day global period, you will [...]

Thyroid Coding: Find Out When to Report Dissections Separate From Thyroidectomy   (December 2011)

Heads up: “Functional,” “selective,” and “radical” refer to the same procedure. Thinking you know thyroidectomy codes through and through may set you up for disaster. You really have to study the code descriptors and know the terminology associated with neck dissection to accurately code these procedures. Tip: When coding for thyroidectomy procedures (60240-60271), keep a close eye on the code descriptors. “Many of them include all of the procedures that the otolaryngologist performed, so you [...]

OIG Report: Pay Attention to E/M Levels, G Modifiers, and More, OIG Warns   (December 2011)

Check your compliance on the areas in the 2012 Work Plan before OIG does.Every practice knows that with payer audits and recoupment requests coming in, now is the time to step up your compliance but where do you start? The HHS Office of Inspector General (OIG)’s 2012 Work Plan, released on Oct. 5 can point you in the right direction.The OIG has some big plans next year for reviewing Part B claims, and they span [...]