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Otolaryngology Coding Alert

Fulfill Audio Test Delivery Requirement to Avoid Overcharging
Breaking news: Not all test administrations deserve equivalent pay Think using the same... Read more
CPT Update:
Make Sure You Ask for More Money When Allowed
Modifier 22 notes will need to detail increased work and reason If you disagree with an... Read more
Prepare Your Practice for 5 G-Tube Changes in 2008
You-ll need a new code for through-skin placement Your gastrostomy tube coding just got... Read more
Reader Questions:
Code Desensitization per Hour
Question: My physician had to provide desensitization to a medicine a patient is allergi... Read more
Reader Questions:
PQRI: Switch to 4048F for Treatment
Question: Measure #20 (Perioperative care: timing of antibiotic prophylaxis -quot; order... Read more
Reader Questions:
30903 and 30905 OK When This Happens
Question: The emergency department (ED) called our otolaryngologist into the hospital at... Read more
Reader Questions:
Consult Medicaid on Interpreter T Code
Question: Is there a code for using an interpreter? Oklahoma Subscriber Answer: Alth... Read more
Reader Questions:
Check Carrier's J0585 Itemization Rules
Question: A patient with spasmodic dysphonia presents for percutaneous botox injections ... Read more
Reader Questions:
Pay Attention When Checking Boxes
Question: An internal audit found that the otolaryngologist's documented review of syste... Read more
Reader Questions:
OIG Cracks Down on 2 Items
Question: What can I expect the OIG to focus on in 2008? Washington Subscriber Answe... Read more
You Be the Coder:
Should You Break Out Dissection?
Question: An otolaryngologist removes both thyroid lobes. But when removing a malignant ... Read more
Find Out Which 69210, 92504 E/M Bundles You Should Appeal
These 5 ear-procedure do's and don-ts will get money in your door fasterIf you have the in... Read more
Correction:
Nasal Function Studies
The article -Expert Advice: Get 92512 Covered in 5 Appeal-Winning Steps- in Vol. 9, No. 10... Read more
Clip and Save:
Spot This Documentation to Confidently Report 31575
These reasons and indications clue you in that scope is medically necessaryNot sure if you... Read more
Adhere to Audiometry Edits You Won't Find in CCI
Audiologists use VRA, CPA for patients who can't participate in threshold testsOnce you ha... Read more
READER QUESTIONS:
Locate a Code for Thyroplasty
Question: What CPT code should I use for the following procedure: Patient has (R) thin, ... Read more
READER QUESTIONS:
CMS Limits CPO to Plan's Chief
Question: Is there any way to get Medicare to pay for care plan oversight visits?North Car... Read more
READER QUESTIONS:
Use Q6 for Occasional Covered Service
Question: When our otolaryngologist is out of town on emergency or on vacation and we call... Read more
You Be the Coder:
E/M-57 Denials
Question: My otolaryngologist submits an inpatient hospital visit code (such as 99223 or 9... Read more
Ask 2 Questions Before Coding Debridement -- or Pay the Price
You can report 31237 as a post-op procedure If denials and quickly advised -don-ts- ar... Read more
Expert Advice:
Get 92512 Covered in 5 Appeal-Winning Steps
Success story: Empire Medicare covers rhinometry thanks to this coder's digging You w... Read more
Exclude Separate Incision Graft From Ear Surgery
You may report harvest from same side, AAO-HNS tells AMA If graft coding in complex m... Read more
Correction
The article ³Expert Advice: Get 92512 Covered in 5 Appeal-Winning Steps should have... Read more
Reader Question:
Myringotomy or Tymp: Look for PE Tube Placement
Question: What is the difference between 69421 and 69436? Ohio Subscriber Answer: Co... Read more
Reader Question:
FTSG Coding: Excision and Graft OK
Question: How should I code a radical resection of malignant ear melanoma with full-thic... Read more
Reader Question:
Combat 30520 Bundle With 3 Strategies
Question: Payers deny septoplasty as inclusive to functional endoscopic sinus surgery (F... Read more
Reader Question:
Stick With E/M for In-Office Tube Removal
Question: My otolaryngologist removed a tympan-ostomy tube that was placed by another ot... Read more
Reader Question:
Avoid Straight Code for 1-Sided Tinnitus Testing
Question: A patient received tinnitus assessment on only one ear. What is the proper way... Read more
You Be the Coder:
Which E/M Code for New Inpatient?
Question: What is the proper inpatient code for a patient whom another physician admitte... Read more
Let 3 Scenarios Steer Your TNE Coding
AAO cuts through AMA-caused confusion If recent AMA advice has you headed to an unlis... Read more
Take 5 Steps as Albuterol J Codes Become Invalid
You can still get paid for noncompounded solutions, but you-ll need to switch to Q codes... Read more
Don't Include Changing Technology in 92547
Good news: VNG accessory coding may be down the pike If you think that 92547 hasn't b... Read more
Private Payers May Still Accept J7611-J7614
Clip and save your inhalation solution coding guide You can get paid for albuterol and ... Read more
Reader Questions:
Focus on Approach for CSF Repair Code
Question: An otolaryngologist and neurosurgeon are doing a surgery together. The patient... Read more
Reader Question:
Expect Consult Confusion to Continue
Question: Has CMS sorted out the difference between a consult and a transfer of care? Wi... Read more
Reader Question:
Use 3 Tactics to Fight G0268-E/M Bundle
Question: The major Florida carriers, except for Humana, paid G0268 in 2006. We are havi... Read more
You Be the Coder:
Lots of Scopes
Question: An otolaryngologist -seems- to be doing an endoscope on every patient at every... Read more
Beware:
31233, 31235 Now Require This Same-Session Procedure
Endoscopy of patient with existing sinusostomy counts as 31231, AAO says Not sure if... Read more
Add $245 to 60240 Claim That Contains 60512's 2 R's
This ammo will help you combat insurer's autotransplantation base-code snafu You can ... Read more
Reader Questions:
Treat Multiple 30117s Like 114xx, 116xx
Question: A private insurer denied a claim for 30117 with modifier 50 (Bilateral procedu... Read more
Reader Questions:
Use 2 Codes When ENT Occludes Canal
Question: What CPT code should I use for "posterior semicircular canal ablation," which ... Read more
Reader Questions:
Lavage Doesn't Count as 69210, AMA Says
Question: A speaker recently advised our practice that we shouldn't report 69210 when th... Read more
Reader Questions:
Modifier 52 Requires Base Surgery
Question: I understood that 69450 (tympanolysis) is for time spent cleaning out a patien... Read more
You Be the Coder - Is Graft Inherent in Myringoplasty?
Question: An otolaryngologist performed myringoplasty (69620) and harvested a graft. Can... Read more
Rehaul Your Superbill With ICD-9 2008's ENT-Intensive Changes in 5 Easy Steps
You'll need side-specific details to use new hearing loss codesIf you love attention, ICD-... Read more
ICD-9 2008 Update:
Identify Area With Specific Dysphagia, Lymphoma Dxs
Code 787.20 comes to the rescue when ENT can't discern problem stageWhen four specific dys... Read more
Prepare for Your Starring Role in ICD-9 2008's Hearing-Focused Debut
Red flag 389.2, 787.2 in your computer system to avoid post-September invalid-code denials... Read more
Use 25 to Overturn Denial of OV With 95115 or 95117
Medicare now allows same-day E/M service and allergy injection -- and your payers should, ... Read more
Educate Payers on CMS' New Same-Day E/M-Shot Policy
These ready-to-go appeals letters will help you get your office visits paidCombat denials ... Read more
ICD-9 2008 Update:
Find Out When to Report 2 Allergy Symptoms
Don't code -runny nose- every time you see oneAlthough new entries for -runny nose- and -s... Read more
Stop Shying Away From Charging for Phone Calls
Society supports payers reimbursing telephone care If you choose to bill for allergist-ma... Read more
READER QUESTIONS:
Combat 69801 POS Denials With Ammo
Question: The Otolaryngology Coding Alert, Vol. 9, No. 4, article on Decadron injections l... Read more
READER QUESTIONS:
Use V5264 When You Break Down Dispensing
Question: Is there a code for making a hearing aid (HA) mold? How should we calculate the ... Read more
READER QUESTIONS:
Stick With 1 Unit of 31233-50
Question: A surgeon insists on billing bilateral nasal endoscopies 31233, 31235 and 31237 ... Read more
READER QUESTIONS:
Identify Target to Pinpoint Injection Code
Question: An otolaryngologist injects Kenalog into a hemangioma located in the ear canal. ... Read more
READER QUESTIONS:
Antigens--Should You Use 1 Line?
Question: How should I bill preparation of three separate 10-dose immunotherapy vials (u... Read more
READER QUESTIONS:
Take These Steps to Show PFSH Checked
Question: Can I count past, family, social history (PFSH) items that I record using a sh... Read more
READER QUESTIONS:
Must You Always Follow CCI Edits?
Question: When specialty-society guidelines differ from National Correct Coding Initiati... Read more
READER QUESTIONS:
Look Beyond HPI for Chronic Condition
Question: The 1997 audit guidelines state that I can reach an extended history by updati... Read more
READER QUESTIONS:
Don't Bill Separately for 94060 Puffs
Question: Which J code should I report for the medication that we administer in the mete... Read more
You Be the Coder:
4 Turbinate Procedures--How Many CPT Codes?
Question: An otolaryngologist does bilateral outfracture of inferior turbinates and bilate... Read more
You Be the Coder:
Diagnosing Multisystem Reactions
Question: After a bee stings a 12-year-old boy with a history of atopic dermatitis (691.8,... Read more
Stick With E/M for Ear Wick Placement -- But Don't Miss Visualization Charge
AAO-HNS confirms -traditional- service coding for this procedure Although alternative sur... Read more
Act as a Co-Surgery Team to Ensure 62.5% Payment
ENT's portion requires specification, individual documentation When your otolaryngologist... Read more
Test Your Thyroidectomy Dissection Coding Skills
Functional, selective, radical refer to the same procedure Nine codes and five terms can ... Read more
Reader Questions:
Report Fungal Sinusitis With Combination of Codes
Question: Is there is a specific diagnosis code for fungal sinusitis?Tennessee Subscriber ... Read more
Reader Questions:
Check With Payer for AuD Credentialing
Question: The February 2007 Otolaryngology Coding Alert article on billing audiological di... Read more
Reader Questions:
69310 vs. 69140: Look for Reconstruction
Question: An otolaryngologist performs a canaloplasty with osteoma excision to treat steno... Read more
Reader Questions:
Before Coding Replacement, Check POS
Question: What code should we use for replacing a Blom-Singer prosthesis?Wyoming Subscribe... Read more
Reader Questions:
Make Sure Note Shows Microdissection
Question: When an assistant surgeon does microdissection and the otolaryngologist performs... Read more
Reader Questions:
42825 Sometimes Involves Suture
Question:  An otolaryngologist performs a tonsillectomy and a primary closure of a to... Read more
You Be the Coder:
Cyst Excision: 11440 or 40810?
Reviewed on May 12, 2015  Question: Which CPT code should I use for surgical ex... Read more
Is Your Practice Doing Concha Bullosa Work for Free?
Most ENT's are giving it away, but here's why you can bill 31240 separatelyIf you now bund... Read more
Check This Bundling Guide Before You Report Middle Turbinate Surgery
Educational opportunity:  This summary puts you 1 CEU closer to your goalCross off an... Read more
Use 61795 to Add $250+ to FESS Claim Under These Circumstances
5 answers ensure you report stereotactic guidance only when you shouldIf you appropriately... Read more
Stop Rushing to Switch Over to the New CMS-1500
CMS gives you a breather due to incorrect formsDon't discard your old CMS-1500 forms just ... Read more
READER QUESTIONS:
Expect 2 Possible CPT Codes for TNE
Question: How should I code a transnasal esophago-scopy (TNE)? Louisiana Subscriber... Read more
Make Your Opinion Count:
Go Online to Back At-Home OSA Evaluation
Code 327.23 testing could be more easily attainable and less expensiveCMS wants your help ... Read more
READER QUESTIONS:
Apply Incident-to Rules to MA Services
Question: Can a certified medical assistant (MA) bill 99211 with or without an otolaryngol... Read more
READER QUESTIONS:
Is Graft + Tympanoplasty OK?
Question: An otolaryngologist performs a tympanoplasty with mastoidectomy and makes a sepa... Read more
READER QUESTIONS:
Not All E/M Rules Require Patient Presence
Question: A patient's father came in to review test results without the child present. Sho... Read more
READER QUESTIONS:
Reserve 31579 for More Than Video Making
Question: What code should we use for videostroboscopy?South Dakota Subscriber Answer: CP... Read more
You Be the Coder:
Account for Epistaxis With Coumadin
Question: A new patient comes in to your office with a nosebleed. The otolaryngologist eva... Read more
Gain Almost $700 for Decadron Injection That Qualifies for 69801
Labyrinthotomy code applies to perfusion of steroid, not just gentamicinUsing 90772 instea... Read more
Bookmark the Fast Facts You Need on Coding Perfusions
Bonus: This summary can put you 1 CEU closer to reaching your renewal requirementTip: Put ... Read more
Debunk 5 Myths of Coding for Audiological Tests
Reimbursement matches MD's when audiologist bills 92552-92557 and moreDon't let incident-t... Read more
Designate These Hearing Codes as AuD NPI Ones
  These diagnostic tests should be billed directly, not incident-toYou-re taking the... Read more
Get Up to Speed on the New CMS-1500 Form
Make sure your software is ready to handle the changesJust when you think you-re prepared ... Read more
Correction:
Medicare Reduces Pay on Some NPP, Not AuD, Billed Claims
This reduction does not apply to audiologists- billed servicesDon't worry about losing pay... Read more
Breathe Easy When You Code EAA Workup Using These Steps
Hint: 94010, 94375 are shoe-ins for bundled statusA workup for possible extrinsic allergic... Read more
Get the Scoop on Xolair Administration Coding
2 societies say omalizumab falls under 90772If 90772 and 96401 came with a drug reference ... Read more
Avoid Underreporting Omalizumab Services With 4 Items
You code it: Asthma patient receives Xolair injectionA completed CMS-1500 form for adminis... Read more
Welcome 2 Changes to Allergy Test Code
Thank CMS for increased antigen payment and quantityThe next time you report allergy titra... Read more
READER QUESTIONS:
Must You Always Follow NCCI Edits?
Question: When specialty-society guidelines differ from National Correct Coding Initiative... Read more
READER QUESTIONS:
Opt for Site-Specific Biopsy Code
Question: Should I use 11100-11101 or 69100 for the following operative report: Patient ha... Read more
READER QUESTIONS:
Look Beyond HPI for Chronic Condition
Question: The 1997 audit guidelines state that I can reach an extended history by updating... Read more
READER QUESTION:
Find Code for Rotation Flap
Question: My doctor did a major ear surgery on a man who has radiation necrosis of the tem... Read more
READER QUESTIONS:
NPPs Can Share Certain Hospital Visits
Question: Can an initial hospital visit be split/shared?California Subscriber Answer: You... Read more
READER QUESTIONS:
No Inpatient Contact = No E/M Service
Question: I read -When reporting discharge day management service, you must provide and do... Read more
READER QUESTIONS:
Use Respiratory Dx for Wheezing
Question: Concerning coding of acute bronchospasm (519.11), when is it appropriate to simp... Read more
READER QUESTIONS:
CPAP and Hospital Care--1 Code or 2?
Question: An allergist performed CPAP (94660) in addition to 99233. Should I separately bi... Read more
READER QUESTIONS:
Bill 94762 for the Equipment
Question: When an allergist performs 94762 on hospital inpatients, may I bill for the code... Read more
READER QUESTIONS:
Use Modifier to Report Inhalations
Question: When I bill two units of 94640, insurers deny the second charge as duplicative. ... Read more
READER QUESTIONS:
Click Your Way to 94060 Updates
Question: I have a report of a patient with documented asthma and shortness of breath, and... Read more
READER QUESTIONS:
Bill 2nd Opinions 2 Ways
Question: I know that CPT deleted the confirmatory consult codes for billing second opinio... Read more
You Be the Coder:
Is 42962 Tied to 42826?
Question: A patient had resection of an oropharyngeal cancer about a month ago.The pectora... Read more
You Be the Coder:
Solve 94640 Denial Using These Tools
Question: I reported a sick visit, in which a strep test and nebulizer treatment were perf... Read more
Crack Down on Flexible Laryngoscopy Coding Mishaps With These FAQs
Secret: Larynx versus nasopharynx makes the difference between 31575 and 92511 Don't give... Read more
Read Latest Instructions on Billing FESS Using Balloon
You should use existing codes under these conditions, AAO-HNS says The Academy has tak... Read more
Sidestep Turbinate Coding Mistakes With RF Terms
Coblation points you to 30801-30802 You can take the mystery out of coding for radio freq... Read more
Rely on This Tool to Avoid Unbundling or Underreporting Turbinate Procedures
Now you can factor in the applicable rules for coding single, multiple, same-side and oppo... Read more
READER QUESTION:
Include 2 Procedures in 69620
Question: An otolaryngologist writes that he performs -bilateral middle ear exploration, w... Read more
READER QUESTION:
Fee Schedule Boosts RVUs for 41155
Question: The February 2007 Otolaryngology Coding Alert lists the 2007 work relative value... Read more
READER QUESTION:
Bill 99221-99223 When Face-to-Face Occurs
Question: Can we charge an office visit and admit on the same day if the otolaryngologist ... Read more
READER QUESTION:
CMS and CPT 'Consult' Criteria Differ
Question: Past Otolaryngology Coding Alert articles contain definitions that differ from C... Read more
READER QUESTION:
Count Botox Indirect Injections per Group
Question: An otolaryngologist uses Botox injections as chemodenervations of muscles for th... Read more
YOU BE THE CODER:
How Should You Code Resection?
Question: How should I code for partial resection of the inferior turbinates? For instance... Read more
Celebrate Congress' Relief of Planned Pay Cut
2007 fee schedule still raises cognitive services- work RVUs The 2007 Medicare Physician ... Read more
Look Forward to More Work Values for Larynx, Neck and Throat Codes
CMS grants RVU hike, but most numbers fall short of requests You can anticipate a gain of... Read more
CASE STUDY:
Translate Nasal Notes Into a Flawless Claim
This op report tests your sinus and turbinate coding skills You can unravel a tricky sinu... Read more
Balloon Sinuplasty Article Clarification:
Expect AAO-HNS to Issue Follow-up Letter
In response to questions and concerns regarding the December 2006 Otolaryngology Coding Al... Read more
READER QUESTION:
Let Insurer Steer Nerve Monitoring Billing
Question: May I bill for facial nerve monitoring, such as for 100 minutes with a total thy... Read more
READER QUESTION:
Apply Incident-to Rules to Tech Audios
Question: Our three-ENT, two-audiologist office recently hired an audiology technician who... Read more
READER QUESTION:
Sub Care Leads to I&D: 1 Code or 2?
Question: An otolaryngologist admitted a 10-year-old boy to the hospital for acute right n... Read more
READER QUESTION:
69433 vs. 69436: Look at Anesthesia
Question: Does the description of 69436 (Tympanostomy [requiring insertion of ventilating ... Read more
READER QUESTION:
31541 Includes Strippings and Removal
Question: Can I bill 31541 bilaterally to represent a bilateral laryngoscopy with operatin... Read more
READER QUESTION:
Bill 92504 Under 2 Circumstances
Question: When should I use 92504? Would you give an example showing appropriate 92504 rep... Read more
READER QUESTION:
Check for Scope Before Coding Tongue Biopsy
Question: Should I use 42800 or 42802 for the following procedure:The mass was just in fro... Read more
YOU BE THE CODER:
Is This Codeable as a Repair or a Flap?
Question: An otolaryngologist performed closure of septal perforation with a pedicled infe... Read more
Tell if You're Over/Undercoding Inferior Turbinate Procedures With This Test
Teach staff this rule: 1 turbinate = 1 code The feds and local authorities are cracki... Read more
Get the Lowdown on CMS Transfer-of-Care Regs
Don't let narrow interpretations stop you from using 99241-99245 for tube candidates You ... Read more
Stop Trying to Read the Requesting Physician's Mind -- Use This Confirmation Sheet Instead
Consult or referral? Here's how to tell 100 percent of the time Pinpoint whether a primar... Read more
Follow 2 Rules When Using New Inhalation Codes
CPT introduces 2 time-based codes with practice expense When you update your encounter sh... Read more
Hone Your Modifier 25 Policies With These Rules
Private payers may drop the modifier requirement for medicine/service claims You finally ... Read more
CODING QUIZ ~ Take 5 Minutes to Test Your NPP Coding Skills
Can you bill incident-to in the hospital? The answer may surprise you You might think you... Read more
NEWS BRIEF ~ Look Beyond CMS Web Site for NPI Applications
CMS removed the NPI PDF from its Web site, but you have other options This list makes obt... Read more
READER QUESTION ~ Learn Exception to Indented Code Rule
Question: Should we assign 31254 and 31255 for an anterior ethmoidectomy?Florida Subscribe... Read more
READER QUESTION ~ Report 041.11 Without Site
Question: What is MRSA sepsis, and how should I code it?Kentucky Subscriber Answer: -MRSA... Read more
READER QUESTION ~ Distinguish Between Laryngoscopies
Question: What is the difference between a direct and indirect laryngoscope?Connecticut Su... Read more
READER QUESTION ~ Include Tube Removal in Repair
Question: I interpret the December 2006 Otolaryngology Coding Alert -Reader Question: Appl... Read more
READER QUESTION ~ Add a 5th Digit to Your Rhinorrhea Dx
Question: What diagnosis should I use for rhinorrhea?New York Subscriber Answer: Effectiv... Read more
READER QUESTION ~ Endoscopy Is Key to Billing 31233
Question: Would you please clarify the use of 31233? Per CPT description, 31233 is -nasal/... Read more
READER QUESTION ~ Patient Requests:
Consult or OV?
Question: I know that CPT deleted the confirmatory consult codes for billing second opinio... Read more
READER QUESTION ~ Peak-Flow Denial May Be on Target
Question: An insurance company told me that the code I use for peak flow (94250) is incorr... Read more
READER QUESTION ~ Count 'No Fever' in ROS
Question: I have found information and heard at seminars conflicting information regarding... Read more
READER QUESTION ~ Use Modifier to Report Inhalations
Question: When I bill two units of 94640, insurers deny the second charge as duplicative. ... Read more
READER QUESTION ~ Code Each DOS for Observation Stay
Question: I am having trouble with a claim for multiple-day observation care. The allergis... Read more
READER QUESTION ~ Which Codes Apply to Bronchitis?
Question: When I use 491.9 to describe a patient's bronchitis, payers often deny the code ... Read more
YOU BE THE CODER ~ T&A:
1 or 2 Codes?
Question: An otolaryngologist performs a tonsillectomy and secondary adenoidectomy. May I ... Read more
YOU BE THE CODER ~ Code This Emphysema Visit
Question: Which CPT code should we report when an established patient with emphysema (492.... Read more