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Otolaryngology Coding Alert


Combat 69801 POS Denials With Ammo

Question: The Otolaryngology Coding Alert, Vol. 9, No. 4, article on Decadron injections lists 69801's non-facility relative value unit as 18.61. But the Medicare RBRVS book states that there is no nonfacility RVU for this procedure. Our otolaryngologists are concerned that we may be billing incorrectly, so what is the appropriate value?

Minnesota Subscriber

Answer: The 2007 Medicare Physician Fee Schedule (MPFS) Excel file (downloaded from CMS) lists the same transitional total RVUs for 69801 (Labyrinthotomy, with or without cryosurgery including other nonexcisional destructive procedures or perfusion of vestibuloactive drugs [single or multiple perfusions]; transcanal), regardless of place of service. Medicare assigns 18.61 total transitioned nonfacility and facility RVUs to 69801.

Problem: Medicare incorrectly considers the procedure rarely performed in the office. Column H of the MPFS designates 69801 as -NA,- which means -this procedure is rarely or never performed in the nonfacility setting.-

But this designation is inappropriate and perhaps based on the previous definition of 69801. CPT 1997 deleted the phrase -tack procedure- from 69801's descriptor and added -perfusion of vestibuloactive drugs (single or multiple perfusions).- The NA designation may be a holdover from the complex, now-obsolete surgical labyrinthectomy that the original code referred to.

Do this: Contact your Medicare Part B representative and tell her that the American Academy of Otolaryngology-Head and Neck Surgery supports performing 69801 in the office. -An injection of gentamicin is a common procedure performed in an otolaryngologist's office,- states the AAO-HNS in its FAQs on gentamicin injections (see Injections of aminoglycosides such as gentamicin as well as injections of anti-inflammatory steroids such as Decadron are classified to 69801.

Don't forget: When reporting 69801 for a Decadron injection performed in the office, you should also bill for the drug. Code 69801 represents the infusion. For the Decadron, use J1100 (Injection, dexamethasone sodium phosphate, 1 mg).

Remember: Because of 69801's 90-day global period, include all three injections that the otolaryngologist gives in the coding of the first injection, and then bill the subsequent medication only.

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