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Otolaryngology Coding Alert

Procedure Focus:
Follow 5 Simple Steps to Top-Notch Tonsillectomy Claims
Age matters for your starting point. Just because tonsillectomy and adenoidectomy case... Read more
Here's Your Refresher on Documenting Consults
Tip: Be sure it’s clear you see the patient as a ‘loan.’ Medicare st... Read more
Keep Your Epistaxis Coding Simple With a Single ICD-10 Choice
Remember you still have multiple procedure codes associated with diagnosis. Epistaxis ... Read more
Reader Question:
Code 42842 Applies to Tonsil or Pillar Resection
Question: Our physician obtained a biopsy from the anterior pillar and also removed... Read more
Reader Question:
Learn Payer Position on Binaural CI Programming
Question: Our audiologists sometimes bill 92604 with 92626 and 92627 for our follow... Read more
Reader Question:
Check for Stenosis Before Coding Nasal Valve Stenting
Question: The surgeon completed intercartilaginous placement of septal cartilage fo... Read more
Reader Question:
Double Check Administration Route for Depo-Medrol Injection
Question: Our otolaryngologist sometimes gives Depo-Medrol injections to his patien... Read more
You Be the Coder:
Know Your Choices for Normal Hearing Test Results
Question: A patient came to our office with a chief complaint of hearing loss. Her ... Read more
Allergy Treatments:
Verify That Your 95165 Claims Will Pass This Carrier's Closer Inspection
Plus: Follow 3 steps to successful allergy shot coding. Although you might think you&... Read more
CPT® 2016:
Get to Know New E/M Choices 99415 and 99416
New codes will improve how you report prolonged services. You already know that 2016 w... Read more
Get Used to a Broader Descriptor for Acute Laryngitis
Now you won’t specify whether obstruction is present. Acute laryngitis is the ac... Read more
Don't Miss the Latest News on Ménière's-Related Research
Ménière’s disease (H81.0-, Ménière’s disease &he... Read more
Reader Question:
Differentiate Between Simple and Complicated For FBR
Question: Our physician recently removed a glass splinter from a patient’s ne... Read more
Reader Question:
Stick to Integumentary Codes for Wart Removal From Buccal Sulcus
Question: Our physician recently removed ten lesions of verruca vulgaris from the b... Read more
Reader Question:
Select Appropriate Dysphagia Code Based on Swallowing Phase
Question: A patient with carcinoma S/P radiation and chemo has subsequent dysphagia... Read more
Reader Question:
Always Include the Most Specific Diagnosis
Question: Are we required to continue including old diagnoses on a patient claim wh... Read more
You Be the Coder:
Coding for Suboccipital Bone Plate Resection
Question: My physician completed a resection of the suboccipital extradural plate w... Read more
CPT® 2016:
Here's Your Sneak Peek at Coding Changes That Take Effect in January
Don’t miss the latest update to cerumen removal. September brings football seas... Read more
Procedure Focus:
Don't Miss How Closures and Grafts Can Change Your Lesion Coding
Tip: You’ll still start with lesion size plus margins. Lesion excisions might be... Read more
Add a Choice for Allergic Rhinitis of Unspecified Cause
Still search for a more specific code before resorting to ‘unlisted.’ Fall... Read more
Reader Question:
Sialoadenitis Brings More Diagnoses With ICD-10
Question: A patient came to our office because of pain and swelling in the area of ... Read more
Reader Question:
Remember 69801 Can Apply to Some In-Office Procedures
Question: The otolaryngologist administered a transtympanic injection of a steroid ... Read more
Reader Question:
Indicate When Patient Failed First Screening
Question: A patient came to us after failing a hearing screen, but she passed our i... Read more
Reader Question:
Yes, You Can Report FESS With an Open Procedure
Question: A patient was scheduled for functional endoscopic sinus surgery (FESS), b... Read more
Reader Question:
Code 31535 Covers Direct Laryngoscopy With Biopsy
Question: I’m coding for a direct laryngoscopy with biopsies of the central a... Read more
Reader Question:
Watch Laterality Before Filing 31292 and 31255 Together
Question: We just started doing a lot of 31292 (orbit compressions) and I have two ... Read more
You Be the Coder:
Laryngeal Injection Coding Depends on Its Purpose
Question: Our ENT administered percutaneous laryngeal injections using flexible end... Read more
Code Update:
Check Out the New Category III Endoscopy Codes Released in July
Caution: You won’t be able to report them until 2016. The American Medical Asso... Read more
CMS Announces Proposed Changes to 2016 - Some Good, Some Bad
The biggest issue is RVU reduction. Preparing for your 2016 fee updates will be good i... Read more
Diagnosis 473.8 Will Have Similar Descriptor in October
Just one more detail will separate it from your current choice. When your otolaryngol... Read more
Reader Questions:
Diagnosis 765.10 Will Shift to P07.00 or P07.10
Question: One of my doctors is a pediatric otolaryngologist, and he sees a lot of p... Read more
Reader Questions:
Code Separately for Alloderm Graft With 15275
Question: The surgeon performed 30420 including cartilage grafts and an Alloderm gr... Read more
Reader Questions:
Start With 709.2 for Visit Due to Trach Site Pain
Question: A patient came to our office for evaluation of her trach tube with pain a... Read more
Reader Questions:
Get Clear Documentation of E/M With VNG Testing
Question: Our audiologist performed a VNG test in our office. We reported codes 925... Read more
Reader Questions:
Turn to 42299 for CAPSO
Question: What is the CPT® code for a cautery-assisted palatal stiffening opera... Read more
You Be the Coder:
The Correct Code for Flexible Laryngoscopy
Question: Our otolaryngologist administered a laryngeal injection through a flexibl... Read more
Procedure Focus:
Get Clear on When You Can Include E/M and Modifier 25 on Scope Claims
Tip: Look to the AAO-HNS for some helpful guidance. Diagnostic scopes can be some of t... Read more
Diagnosis Coding:
Watch the Diagnosis Assignment When Submitting Modifier 25
You might need to fight for reimbursement. You can connect the same diagnosis with bot... Read more
Follow These 3 Pieces of Advice to Find 'Unlisted' Success
The more information you can include on your claim, the better.  No coder likes t... Read more
You'll Still Have a Single Code for Hypertrophy of Adenoids, Come October
Current diagnosis 474.12 will make an easy shift.  When your otolaryngologist dia... Read more
Reader Questions:
Look at Separate Lines When Appealing Bilateral Denial
Question: One of our commercial payers has been denying the bilateral portion of 31... Read more
Reader Questions:
Remember the ''Established'' Timeline
Question: A patient was referred to our practice in 2013 because of otitis media, a... Read more
Reader Questions:
Inpatients Remain Inpatients Until Discharge
Question: We were asked to perform a consultation for a hospital inpatient who was ... Read more
Reader Questions:
Append Modifier 78 for Unplanned Return to OR
Question: My provider did a tonsillectomy on a patient a couple weeks ago. The pati... Read more
You Be the Coder:
ICD-10 Options for Retained Foreign Body
Question: I’m trying to determine what the correct ICD-10 code would be for 3... Read more
Are You Explaining Yourself Clearly on 'Unlisted' Claims?
Think ‘streamlined’ and ‘simple language’ to find success. If ... Read more
Clip and Save:
Get Familiar With Your 'Unlisted' Options
You have several choices for each ENT anatomic site.  Coders try to avoid usin... Read more
Back to Basics:
Get the Scoop on 3 Everyday Questions From NGS - and How They Might Change Your Coding
Tip: Document pain level as part of ROS. A recent “Part B Ask the Contractor&rdq... Read more
You'll Still Have a Single Code for Nasal Cavity Polyp in October
Be sure to differentiate between polyps and lesions before coding. When your otolaryng... Read more
Reader Questions:
Append a Modifier to Report 31588 With 31575
Question:  Can a provider bill 31588 with 31575? Iowa Subscriber Answer:  ... Read more
Reader Questions:
Yes/No to Provider Presence During Allergy Shot Administration
Question:  What is the rule for administering an allergy shot without a provider pr... Read more
Reader Questions:
Look to 131xx Series for Lesion Excision - Most of the Time
Question: My doctor needs to excise a scar on a patient that had a parotid mass exc... Read more
Reader Questions:
File With 31299 and Paperwork for Propel Sinus Stent Placement
Question:  My surgeon is getting information about the Propel sinus stent. If he of... Read more
Reader Questions:
Choose 17110 or 17111 for Laser Hemangioma Excision
Question:  What are the correct procedure and diagnosis codes for hemangioma excisi... Read more
Reader Questions:
Watch the MUEs for Any Medicare Claim
Question: We are having trouble with our VNG claims for the last quarter of 2014. We wer... Read more
Reader Questions:
Diagnosis 478.79 Will Shift to J38.7 for Chondritis of Larynx
Question: What is the correct diagnosis code for chondritis of the larynx?  ... Read more
You Be the Coder:
The Best Code for Conchal Bowl Erythema Treatment
Question: Our surgeon treated a patient with erythema of the conchal bowl and marke... Read more
CCI 21.1:
Watch How You Submit Tonsillectomy Claims, Thanks to New Coding Edits
Tip: Scrutinize descriptor details to know what you can’t submit together.  ... Read more
Say "Good-Bye" to the SGR Formula, "Hello" to ICD-10 -- Probably
Plus: Extra pay could be coming your way this summer.  The Medicare Access and CH... Read more
Sinus Procedures:
Follow These 8 Tips to Successful Endoscopic Surgery Claims
Hint: The more you know details, the easier your coding will be.   Endoscopic sin... Read more
Prepare for More Detailed Diagnoses for Acute Swimmer's Ear
Your providers will need to document laterality beginning in October. With warm weathe... Read more
Reader Questions:
Congenital Atresia Diagnosis Will Shift From 744.03 to Q16.4
Question: What are the correct procedure and diagnosis codes for a single stage rec... Read more
Reader Questions:
Here's Why You Can't Submit 92504 with 69210
Question: I recently attended a course where the instructor said we could bill 92504 ... Read more
Reader Questions:
99211 Might Go Along With Ragwitek Administration
Question: We will be dispensing a medication called Ragwitek to our first patient i... Read more
Reader Questions:
Only Append Modifier 22 for Extra Work, Not Extra Time
Question: Our surgeon completed a parathyroidectomy with frozen section and several... Read more
Reader Questions:
Watch What You Submit With +92547
Question: Medicare has started denying our claims with five units of 92547, stating... Read more
You Be the Coder:
First Step for Coding Sinus Hydrodebridement
Question: What is the correct code for hydrodebridement of sinuses? Massachuset... Read more
Allergy Coding:
Beware of Bundles Before Filing an EAA Claim
Your diagnosis choice is simple, but procedures can cross up. Most allergy patients yo... Read more
Prepare for Direct Switch for Laryngeal Spasm Coding Later This Year
You’ll have a single code, but don’t misreport with a less specific option.&... Read more
E/M Coding:
Check Whether a 'Mix and Match' Approach to Guidelines Will Help Your Coding Levels
CMS says you no longer have to stick with only 1995 or 1997 rules.  For some paye... Read more
Reader Questions:
Choose Between 21452 and 21453 for Mandibular Fracture Fixation
Question:  The otolaryngologist did several procedures to repair multiple fractures... Read more
Reader Questions:
Include RT/LT - Not 50 - With 60212
Question: My physician performed surgery on both the right and the left lobes. The CPT&r... Read more
Reader Question:
Remember That Edits Bundle 38700 and 42440
Question: My physician noted that he performed “Right radical submandibular g... Read more
Reader Question:
'Unlisted' Could Be Best Code for Septal Tumor Debulking
Question: The otolaryngologist debulked a large septal tumor. She didn’t exci... Read more
Reader Question:
Office Visit Codes Don't Work for Inpatients
Question: One of our physicians was called and asked to do a consult on an inpatien... Read more
You Be the Coder:
Coding for Endoscopic Middle Turbinate Removal
Question: The otolaryngologist performed a middle turbinate removal endoscopically,... Read more
Procedure Focus:
Don't Fall Into These 4 FESS Coding Traps
Details in the surgeon’s notes make all the difference. As an otolaryngology cod... Read more
Be Aware of RVU Differences for FESS Procedures
Never ‘code for dollars’ by submitting higher RVU values.   The diffe... Read more
Get Easy Answers to 3 Top Laryngeal Procedure Questions
Like it or not, ‘unlisted’ sometimes is the best choice. Your otolaryngolo... Read more
Don't Be Disturbed by New Code Options for Dry Mouth
ICD-10 adds one more option for consideration.  Xerostomia, or dry mouth, is a co... Read more
Reader Question:
Remember Cochlear Implant Includes Initial Removal
Question: Is it appropriate to bill for removal of a cochlear implant and reimplant... Read more
Reader Question:
Base Tracheostomy Debridement Coding on Measurements
Question: I need help coding for a tracheostomy debridement. I’ve been using ... Read more
Reader Question:
Payer Determines Whether You Bill 42961 for Post-Op T&A Bleeding
Question: A patient had a tonsillectomy and adenoid removal. She was hospitalized f... Read more
Reader Question:
Turn to 42420 for Parotidectomy
Question: Our physician performed the following procedures:  1. Left total s... Read more
Reader Question:
Verify That Audiologist Has MD Supervision for 92540
Question: I am trying to find out what type of supervision is required when an audi... Read more
You Be the Coder:
Documenting a Claim With 31297 and 21337
Question: Our otolaryngologist performed a balloon dilation, and had to fracture th... Read more
Neck Procedures:
Learn the Ins and Outs of Neck Dissection Coding
Here’s your quick refresher on what each procedure involves.  If your otola... Read more
Terminology Check:
Brush Up on These Familiar Neck Dissection Terms
Understanding anatomy always helps you code more accurately.  Because neck dis... Read more
Understand the Different Types of Sinusitis to Code Correctly
Heads up: Watch for varying definitions among groups.  Sinusitis is a common cond... Read more
Anatomy Refresher:
Do You Know Where Your Sinuses Are?
Learn skull structure to remember which is which.  The paranasal sinuses are loca... Read more
CMS Could Start Paying MDs Based on Quality, Not Numbers of Procedures
Changes could be implemented as soon as late 2016. If the Department of Health and Hum... Read more
Reader Question:
Remember Edits Normally Bundle 12042 and 11420
Question: We billed CPT® codes 12042 and 11420 with modifier 51.  I billed the 1... Read more
Reader Question:
69220 Could Work for Bilateral Cholesteatoma Removal
Question: One of our patients comes to the office every three or four months for removal... Read more
Reader Question:
Appeal for Payment if LCD Support Spirometry Diagnosis
Question:My records indicate that spirometry is a coverable CMS expense, but we cannot g... Read more
Reader Question:
There's No Need to Remove PQRS Codes from Secondary Insurer's Claim
Question: If we submit G codes (PQRS codes) to a patient’s primary insurer, should... Read more
You Be the Coder:
Coding for Percutaneous Vocal Cord Injection
Question:Our physician wants to inject Radiesse through the patient’s neck into th... Read more
Throat Procedures:
Don't Miss the Details That Will Lead to Full Flexible Laryngoscopy Payment
Know every detail your physician should be writing. Otolaryngologists often perform di... Read more
Modifier Focus:
Focus on 3 Questions to Correctly Report Co-Surgery Situations
Separate documentation is your key to modifier -62 success. When your otolaryngologist... Read more
Look Ahead to Additional Code Choices for Acute Tonsillitis
ICD-10 will help you assign more accurate diagnoses. Acute tonsillitis might be one of... Read more
Reader Question:
Remember to Bill 92543 Per Irrigation
Question: When we bill 92543, does that code represent the four irrigations as one ... Read more
Reader Question:
Submit 60260 for Cancer Removal After Thyroidectomy
Question: The surgeon’s notes state he removed returning cancer from the thyr... Read more
Reader Question:
Don't Report VNG 'Incident To' When Audiologist Does the Test
Question: Can we bill a VNG as “incident to” a physician even when an a... Read more
Reader Question:
Only Include Modifier -24 for an Unrelated Problem
Question: We sometimes see a patient who will have multiple sinus procedures (31XXX) ... Read more
Reader Question:
Reason for Repeat Procedure Determines Modifier 58 or 78
Question: The patient had an I&D which we coded with 69005. She returned five day... Read more
Reader Question:
Choose V72.11 for Normal Hearing Test After Failed Exam
Question: A mother brought her middle school son to us because he had failed a scho... Read more
Reader Question:
Bill Both 13152 and 69005 With Caution - and a Modifier
Question: A patient presented with a left auricular hematoma from a wrestling injur... Read more
Reader Question:
Steer Clear of Billing Scripts With No Other Service
Question: Can we bill when the physician is only writing a prescription? We want to... Read more
You Be the Coder:
How to Report Vallecular Cyst Marsupialization
Question: The otolaryngologist inserted a Dedo laryngoscope into the oral cavity. T... Read more
Procedure Focus:
Let 3 Scenarios Guide Your Coding for Separate Ear Tube Removal
Some circumstances will let you move past only E/M reporting. Simple procedures such a... Read more
Follow 5 Steps to Ensure You're Handling Specialist Payment Arrangements Correctly
Here’s your guide to splitting service fees with other physicians.  Otolary... Read more
Pay Attention to What Will Be Considered 'Other Congenital Anomalies of Nose'
Your diagnosis choices will expand in October.  Congenital midline nasal masses a... Read more
Reader Question:
Check Possibilities Behind 30802/30465 Denial
Question: Blue Cross Blue Shield is denying payment for 30802 when billed with 3046... Read more
Reader Question:
Global Period Guides Whether Post-op Visit Is Billable
Question: One of our physicians wants to book patients for the first post-op visit ... Read more
Reader Question:
CCI Edits Direct Whether 96372 Is Allowed With Scope
Question: When the otolaryngologist performs a scope in the office and also gives a... Read more
Reader Question:
Related or Unrelated Procedure Distinguishes Modifiers 58 and 79
Question: The physician performed postoperative debridement in the office following... Read more
Reader Question:
Yes, You Can Get Paid for E/M With 69210
Question: One of our physicians would like us to create a letter for commercial pay... Read more
You Be the Coder:
Correct Code for Isshiki Type I Thyroplasty
Question: Several years ago, we were told to report 31599 for an Isshiki type I thy... Read more