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Otolaryngology Coding Alert

Procedure Focus:
Follow These 4 Tactics to Gain Additional Dollars for Concha Bullosa Work
Yes, you can get paid for 31240 with other procedures.  If you’re getting d... Read more
Consultation Coding:
Know How to Handle Claims When a Consultation Is In Question
Don’t automatically dismiss 99241-99245 for every patient.  Although CMS st... Read more
Enlargement of Lymph Nodes Will Have an Easy Code Switch for ICD-10
Remember to look for – and code – additional conditions.  If you come... Read more
Reader Question:
Here's Your Best Code Choice for Dix-Hallpike Testing
Question: In the past, our Medicare contractor paid for the Dix-Hallpike diagnostic... Read more
Reader Question:
Turn to 040.1 for Rhinoscleroma Diagnosis
Question: My physician diagnosed a patient with rhinoscleroma. What is the correct diagn... Read more
Reader Question:
Answer the Sequential Question to Differentiate 95024 From 95027
Question: When should you bill 95027 instead of 95024? I don’t have a complet... Read more
Reader Question:
Submit Only 69610, Not 69610 Plus 69424
Question: Our physician would like to bill an ear tube removal with ear patch toget... Read more
Reader Question:
Complete Paperwork to Document Non-Par Patient Care
Question: A patient called our office to schedule an appointment, knowing that we d... Read more
Reader Question:
Verify Incision Before Submitting 69420
Question: Our surgeon documented a procedure as follows:  PROCEDURE (aspirat... Read more
You Be the Coder:
Know the Parameters for Reporting Counseling With Scope
Question: If a doctor bills a 99204 based on time (45 minute visit with more than 5... Read more
Audiology Focus:
Get Your Orders In Order for Successful Hearing Test Claims
Know whether the procedure automatically includes technical and professional components.... Read more
News Flash:
Look Ahead to New Global Periods Coming Your Way in 2017
Plus: If CMS prevails, you may get paid less for surgical procedures. Global periods a... Read more
E/M Coding:
These 6 Facts Can Help You Know When 99211 Might Apply
Important: Remember, it’s not just for nurse visits.  Code 99211 might be y... Read more
Don't Sneeze at Extra Diagnoses for Allergic Rhinitis
Allergic rhinitis (sometimes called hay fever) is a common condition for your otolaryngo... Read more
Reader Question:
Verify Whether 31295 Is Done With Another Procedure
Question: One of our third-party insurers has sent two denials for claims with code... Read more
Reader Question:
Is Post-op Endoscopy/Debridement Separately Billable?
Question: If the physician performs postoperative nasal endoscopy/debridement in th... Read more
Reader Question:
Include E/M With 31231 and Supporting Documentation
Question: Our patients are examined after FESS with a nasal endoscope, and may not ... Read more
Reader Question:
Look to 42810 for Excision of Preauricular Pit Including Cartilage
Question: The surgeon made an elliptical incision around the preauricular pit and d... Read more
You Be the Coder:
Site of Service Affecting Tonsillectomy Code
Question: One of my doctors is considering doing in-office tonsillectomies.  I... Read more
CPT® 2015:
Prepare Now for Esophagoscopy Code Changes in 2015
Plus: Don’t miss the new codes for chronic care management services.  The A... Read more
2015 Coding Update:
Check Out Your New Alternatives to Modifier 59 in Certain Situations
Modifier 59 is still valid, but use the new modifiers instead when applicable. While y... Read more
Code for Adenoid Hypertrophy Will Have 1:1 Switch
Tip: Documentation of ‘enlargement of adenoids’ signals same condition. Th... Read more
Reader Question:
Still Turn to 31575-31578 for Distal-Chip Scope
Question: Our physician just purchased a flexible laryngoscopy that uses a distal-c... Read more
Reader Question:
Know When to Report G0268 Instead of 69210
Question: I was told that when 69210 became bilateral, G0268 was no longer in use. Someo... Read more
Reader Question:
Insurer Dictates Whether Post-op Complication Care Gets Paid
Question: I’m seeing more denials of claims for post-op complications that re... Read more
Reader Question:
Don't Get Tripped by 31296/31276 Confusion
Question: Our otolaryngologist performed a balloon procedure in an ASC. I billed 31... Read more
Reader Question:
Yes, You Can Normally File 95024 and 95027 Together
Question: One of our third party payers denied two types of allergy testing that we... Read more
Reader Question:
Silver Nitrate Cauterization of Eardrum Perforation
Question: Is there a CPT® code we can use for cauterization with silver nitrate... Read more
You Be the Coder:
Same Site, Multiple Keloid Excisions
Question:The otolaryngologist performed three keloid excisions (sizes 1.2, 1.12, and 0.8... Read more
Procedure Focus:
Follow These 5 Tips for Successful Tracheostomy Tube Replacement Claims
Don’t forget to change your coding tactic for OR procedures. As an otolaryngolog... Read more
Office Services:
Evaluate the Extent of Repair to End Nosebleed Coding Problems
Here’s your guide to reporting E/M codes or 30901. A patient comes to your offic... Read more
Watch for This Change to Otosclerosis Descriptors in 2015
‘Bilateral’ addition will be only difference in new codes.   “O... Read more
Reader Question:
Audiologist Can Help With Intraoperative Nerve Monitoring
Question: An otologist wants to have an audiologist provide intraoperative nerve mo... Read more
Reader Question:
'Unlisted' Might Be Best for Adenoidectomy Via Nasal Approach
Question: Can you please help me with the correct code for superior adenoidectomy v... Read more
Reader Question:
Verify That 59 Gets Appended to the Correct Code
Question: I am having an issue with some commercial payers when the surgeon removes... Read more
Reader Question:
Choose From 42330-42340 for Salivary Stone Removal
Question: Please provide me with the correct CPT® codes for when the physician ... Read more
Reader Question:
Remember G Code for Home Sleep Study
Question: I am new to sleep studies and want to make sure I am doing this correctly... Read more
You Be the Coder:
Understanding the Epley Maneuver
Question: I’m new to ENT coding so have a lot to learn. Can you tell me what ... Read more
Procedure Focus:
Keep These 3 Things in Mind When Submitting 64617 Claims
Don’t miss the minor differences from old code 64613.  CPT® 2014 introd... Read more
Modifier Usage:
Here's Your 3-Step Plan to Collect Modifier 25 Pay
Remember Medicare has certain criteria to meet.  It’s not unusual for an ot... Read more
Don't Be Disturbed by Additional Codes for Disturbances of Smell and Taste Sensation
ICD-10 will teach you to code based on the specific condition. An estimate of about 2 ... Read more
Look for This to Find Better Charge Capture
Electronic options help you in 6 important ways.  Any coder can have trouble capt... Read more
Reader Question:
Resort to 'Unlisted' for Abutment Removal and Replacement
Question: Our doctor is removing an abutment and replacing it with a longer one. We... Read more
Reader Question:
42415 Represents Facial Nerve Dissection and Cyst Removal
Question: I’m coding for a procedure that started out as a parotidectomy with... Read more
Reader Question:
Two Procedures, With and Without Operating Microscope
Question: The otolaryngologist performed two procedures during an operative session... Read more
Reader Question:
Start With 1144x for Preauricular Fistula
Question: I’m struggling with coding this procedure. Documentation reads, &ld... Read more
Reader Question:
Consider 35800 for Tracheostomy Wound Exploration
Question: I’m looking for the correct code for tracheostomy wound exploration... Read more
Reader Question:
Yes, You Can Bill Nasal Endoscopy During Post-Op Period
Question: A patient recently had sinus surgery and is following up with our physici... Read more
Reader Question:
Report 41120 for Partial Resection of Tongue
Question: What is the correct code for robotic resection of the base of the tongue?... Read more
You Be the Coder:
Check This to Decide Between 30130 and 30140
Question: The surgeon documented that he used a blade to submucosally excise tissue... Read more
Condition Focus:
Get the Lowdown on Sleep Apnea and Hearing Loss
Hint: Knowing the type points you to the diagnosis. A study presented at the 2014 Amer... Read more
Research Rundown:
Study Shows That Certain Ethnicities Could Be More Prone to Hearing Loss With Apnea
High frequency hearing impairment outweighed low.  The research study found that ... Read more
Payer Update:
Watch When You Can Submit E/M With Modifier 25
Another payer says it’s rarely allowable.  With insurers seeming to constan... Read more
Coding Update:
Here's Your Good News for Filing 69210 With E/M Codes
Get ready for reprocessed claims to earn extra dollars from Cigna.  With one of t... Read more
Prepare to Track Number of Visits for Treatment of FBR in Nose or Ear
ICD-10 will help you report the service more accurately.   When your otolaryngolo... Read more
Reader Question:
69610 Covers Tube Removal Plus Ear Drum Patch
Question: The following report was submitted by one of our physicians: “The i... Read more
Reader Question:
Watch Your Modifiers When Reporting Part of VNG Service
Question: A local neurology group’s VNG machine is broken and they want to re... Read more
Reader Question:
Remember That 31541 Includes Biopsy
Question: A surgeon performed two procedures during the operative session:  ... Read more
Reader Question:
Follow Payer Preference for Reporting Consults
Question: Our payers always deny our claims with 99283 or 99284, even though we&rsq... Read more
Reader Question:
Higher E/M Comes From More Than Extended HPI
Question: Does an extended HPI guarantee a higher-level E/M code? Washington Subs... Read more
Reader Question:
Know When to Turn to 99499
Question: Can I use modifier 52 on 99201 if my provider only captures history and M... Read more
Reader Question:
Learn the Difference Between NEC and NOS Designations
Question: One thing I’ve seen when looking at the ICD-10-CM manual is the not... Read more
You Be the Coder:
Determine if You Need More Than 69641
Question: I have a question regarding harvesting of graft(s) during tympanomastoide... Read more
Payer Update:
Don't Expect Bilateral Payment for 69210 From These Payers
Official word comes from Medicare on stance, despite AAO-HNS objections.  Otolary... Read more
Watch 3 Things as You Prepare for Changes to Diagnose Ear Conditions
Heads up: The conditions will have their own chapter in ICD-10.  When ICD-10 goes... Read more
Turn to Modifier 63 to Watch 'Small' Surgeries Become Bigger Payments
Tip: Document just as well as you would for modifier 22.  Surgical procedures on ... Read more
Reader Question:
Report Skin Graft Harvest Separate From Repair
Question: I have trouble understanding CPT® code 30620. Part of the descriptor reads... Read more
Reader Question:
Yes, 31600 Is Allowed With Other Neck Procedures
Question: Can you bill CPT® code 31600 with codes 38724, 41120, and 42890, or a... Read more
Reader Question:
Multi-Provider Visit Could Be Shared Service
Question: My physician and a physician’s assistant visited the same patient i... Read more
Reader Question:
Here's When 69320 Is More Fitting Than 69140
Question: The surgeon made a transcanal incision lateral to the apparent osteoma. T... Read more
Reader Question:
Check Location Before Coding Graft During Tympanomastoidectomy
Question: I have a question regarding harvesting of graft(s) during tympanomastoide... Read more
You Be the Coder:
Best Option for Hypopharyngeal Mucocele Removal
Question: How would you code a microlaryngoscopy with removal of hypopharyngeal muc... Read more
Don't Stop Preparing for ICD-10, Despite the Implementation Delay
Silver lining: Congress also halts the expected 24 percent physician pay cut. Otolaryn... Read more
Allergy Testing:
Breeze Through Spring With Denial-Proof Allergy Coding
Counting units, not scratches, is key with 95004. Springtime pollen is upon us, which ... Read more
CCI 20.1:
Check Which Allergy Tests the Latest Coding Edits Focus On
Hint: The test overrides several non-face-to-face services.  New Correct Coding I... Read more
Reader Question:
Establish Payment Agreement With Hospital for Portion of 92586 Payment
Question: Our practice does all of the newborn hearing screenings at a local hospit... Read more
Reader Question:
Middle Turbinectomy Reporting Depends on Other Procedure
Question: Is partial excision of the middle turbinate considered a separate procedu... Read more
Reader Question:
Don't Let Payer Allocate 90-Day Global to +61782
Question: I heard at a coding seminar that some insurance companies are applying a ... Read more
Reader Question:
Justify Modifier 59 Before Submitting 31231 With 31575
Question: The physician completed 31231 in the office for sinusitis, but he also ne... Read more
Reader Question:
Understand When G0268 Outweighs 69210
Question: I billed G0268 with 92511 and had the appropriate documentation for suppo... Read more
Reader Question:
Assign 30125 for Complex Removal of Nasal Palatine Cyst
Question: A procedure report states the following: “An incision was made arou... Read more
You Be the Coder:
Determining Whether Nerve Excision Applies
Question: I am unable to locate a CPT® code for excision of a recurrent larynge... Read more
Know What Diagnostic Endoscopy Involves for Successful Coding
Hint: Remembering one thing will point you in the right direction. Diagnostic endoscop... Read more
NPP Services:
Follow These Q&As; to Keep Your Mid-Level Provider's Service Reporting Incident Free
Ask 3 questions to hone in on details. Billing incident-to for services your non-physi... Read more
Don't Get Mixed Up Over Mixed Hearing Loss Coding
ICD-10 won’t cover all options, so you could turn to ‘unspecified’ mor... Read more
Reader Question:
Combined Diagnoses 388.31, 389.16 Could Justify Moderate Complexity
Question: The physician ordered an MRI and audio impedance test before reaching a diagno... Read more
Reader Question:
Report 17110 for Tympanic Membrane Granuloma Removal
Question: The operative report describes a procedure under general anesthesia as “... Read more
Reader Question:
'Open' or 'Endoscopic' Distinguish 30903 From 31238
Question: What constitutes reporting CPT® code 30903 versus 31238? Michigan Subscr... Read more
Reader Question:
21499 Is Best Option for Eagle's Syndrome Treatment
Question: Our surgeon plans to complete an intraoral excision of bilateral stylomandibul... Read more
Reader Question:
No Biopsy? Then Don't Report 31536
Question: The surgeon documented that he performed direct laryngoscopy with microlaryngo... Read more
You Be the Coder:
Remember G0268 for Medicare Patients Under These Circumstances
Question: I know the descriptor for cerumen removal code 69210 has changed for 2014. Do ... Read more
Watch for Inconsistencies With 69210 Bilateral Payment Before Filing Your Claims
Avoid modifier 50 with CMS, but leave it for private payers. Coders and providers wer... Read more
Improve Provider Documentation by Remembering These Potential Pitfalls
Hint: Ensure that information isn’t being cloned between patient visits. Last m... Read more
Notes of 'Right' or 'Left' Will Help You Dig for the Correct Impacted Cerumen Code
Hint: The H61.2- family will have all your code choices. With coding for impacted ceru... Read more
Reader Question:
Yes, You Can Code 30802 and 30520 Together
Question: An insurer denies 30802 when we bill with 30520. I didn’t think the two ... Read more
Reader Question:
Choose Your Option for Pledgets to Treat CSF Leak
Question: The otolaryngologist applied topical anesthesia before placing three pledgets ... Read more
Reader Question:
Prepare Now for Windows XP Not Meeting HIPAA Compliance
Question: The vendor who keeps our computers updated says we won’t be able to use ... Read more
Reader Question:
Turn to 42299 for RFA of Palate and Uvula
Question: Could you please help me with the following in-office procedure? The diagnosis... Read more
Reader Question:
Say Good-Bye to G8553 for E-Prescribing
Question: Is there a new code to show Medicare that we are e-prescribing in 2014? We are... Read more
Reader Question:
Facility and Practice Ownership Guide OP Allergy Coding
Question: Can an ENT perform outpatient allergy testing at the hospital where he is an e... Read more
You Be the Coder:
Choosing the Best Code for Revised Ethmoidectomy
Question: Our surgeon performed a revised total ethmoidectomy. From my understanding, th... Read more
CCI 20.0:
Don't Jump to Report New Consultative Services Codes, Thanks to Bundling Edits
Tip: Assume modifier indicator ‘0’ applies. The latest rendition of Correc... Read more
Quality Reporting:
Prepare to Implement 4 New PQRS Measures for Otolaryngology in 2014
Also watch for opportunities to report the measure’s group for sleep apnea. CMS ... Read more
Let 3 Tips Start Your Year With Better Provider Documentation
Hint: Legibility and timing are still top concerns. Coding accuracy might be your top ... Read more
Encourage Physicians to Document 'Recurrent' for Future Acute Sinusitis Diagnoses
General descriptors for 461 code family make a straightforward shift. With a new focu... Read more
Reader Question:
Appeal Payer's Decision to Bundle 30560 With 30130
Question: One of our private payers has started bundling 30560 with 30130. I h... Read more
Reader Question:
'Unlisted' 42299 or 69799 Are Best Choice for Rerouting Palatal Muscle
Question: Our ENT wants to offer a new procedure for the treatment of patulous Eustachia... Read more
Reader Question:
Claim With 12051 and 11442 Should Be Allowed
Question: Humana denied our claim listing 12051 with 11442. We’re not sure what th... Read more
Reader Question:
Remember Modifier 59 for 60252/60240 Claim
Question: The surgeon performed a left thyroidectomy for malignancy, with a neck dissect... Read more
You Be the Coder:
Reporting Ear Tube Insertion Under MAC
Question: Our physician removed a patient’s ear tubes in an ASC setting under MAC ... Read more
CPT® 2014:
Follow 3 Steps to Learn the Latest About Endoscopy Changes for 2014
Plus: Watch for closer review of these nasal endoscopy procedures. New codes and addit... Read more
SLP Focus:
Start Reporting HCPCS Codes for Medicare Patient FEESST Services
New G codes from CMS give multiple options for evaluations. If you’ve been seein... Read more
Clip & Save:
Keep These G Codes for Speech-Language Pathology Handy
Tip: Don’t forget to also include a severity/complexity modifier. The G codes th... Read more
CPT® 2014:
Don't Miss These Corrections to CPT® Coding Descriptors
Get clear on ‘qualified health care professional’ definition. CPT® 201... Read more
Nasal Endoscopy Diagnoses Will Have an Easy Transition in October
Nasal Endoscopy Diagnoses Will Have an Easy Transition in October. When your otolaryng... Read more
Reader Question:
Remember That 30117 Is for Singular Lesion Removal
Question: One of our surgeons needs to excise two intranasal lesions and wants to know i... Read more
Reader Question:
Billing for Allergy Tests in Outpatient Department
Question: Our ENT completed allergy testing for a patient in the outpatient clinic, whic... Read more
Reader Question:
Medicare as Secondary Doesn't Change Your Consultation Pay
Question: I know Medicare doesn’t reimburse consults anymore, but a new coder we h... Read more
You Be the Coder:
Additional Reporting of 69801
Question: My physician wants to bill 69801 with modifier 58 two weeks after the original... Read more