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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
ICD-10:
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
ICD-10:
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
ICD-10:
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
ICD-10:
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
ICD-10:
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
Billing:
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
ICD-10:
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
ICD-10:
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
Modifiers:
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
ICD-10:
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
Endoscopy:
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
ICD-10:
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
Reimbursement:
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
Documentation:
Improve Provider Documentation by Remembering These Potential Pitfalls
Hint: Ensure that information isn’t being cloned between patient visits. Last m... Read more
ICD-10:
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
Compliance:
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
ICD-10:
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
ICD-10:
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