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Otolaryngology Coding Alert

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 boost a claim involving 60240 by more than $245 when you meet 60512's criteria. Reporting +60512 (Parathyroid autotransplantation [list separately in addition to code for primary procedure]) can add about $245 to a thyroidectomy claim (the Medicare Physician Fee Schedule assigns 6.48 transitional total relative value units to 60512; 6.48 RVUs x 2007 conversion factor 37.8975 = $245.58). But 60512 carries two requirements. Experts show you how to usurp one "R," removal of four glands, and how to avoid a common payment policy glitch involving the second "R," report with correct base code. Use 60512 When ENT Removes 4 Glands Before green lighting a claim for 60512, look for documentation that supports the full procedure. When the op report indicates the otolaryngologist performed only a portion of 60512, correct procedural terminology requires you to use a modifier. Consider this scenario offered by Lisa May, CPC, at Fletcher Allen Health Care in South Burlington, Vt. "Is it appropriate to code for 60240 (Thyroidectomy, total or complete) along with 60512 (autotransplantation of parathyroid gland), when only one parathyroid gland was removed?" Answer: When the surgeon removes one parathyroid gland for autotransplantation as in this example, you may still report 60512, but you-ll need to use modifier 52 (Reduced services) to indicate a reduced autotransplantation. In 60512, "all four parathyroid glands are completely removed," according to the Coders- Desk Reference. Best practice: "Leave the fee as it is," says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, coding analyst with CodeRyte Inc. in Bethesda, Md. Let the insurer reduce the payment. Send in paperwork showing the reduced portion of 60512. Then the payer will adjust the fee based on the reduction, Jandroep says. Report 60512 With 60240-60271 Based on CPT Check that you can use 60512 as an add-on code with the main procedure you are reporting. The CPT manual lists all thyroidectomy codes (60240-60271) as appropriate base codes for 60512. Anticipate Rejection on Non-Parathyroid Claims Some payers restrict 60512's base code to parathyroidectomy codes (60500-60505), says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, director of outreach programs for the American Academy of Professional Coders based in Salt Lake City. The Correct Coding Initiative (CCI), however, bundles parathyroidectomy codes with thyroidectomy codes (60240-60271). So you should never bill parathyroidectomy in addition to thyroidectomy, which makes appeals for incorrect base code denials challenging, she says. Example: An otolaryngologist performs thyroidectomy with radical neck dissection (RND), which requires autotransplantation of all four parathyroids, and explores the parathyroids. CCI bundles parathyroidectomy into thyroidectomy. So you code the thyroidectomy with RND (60254, Thyroidectomy, total or subtotal for malignancy; with radical neck dissection), not the exploration [...]