Kristin Posted 6 month(s) ago
Our ENT performs balloon sinuplasty procedures and uses stereotactic guidance. Per SuperCoder, +61782 is an add-on code for 31296. Medicare keeps denying 61782 stating the code cannot be billed separately. Initially, we were entering the codes into our EMR system and had 61782 as the last code and thought that was why this code wasn't being paid. So we started entering the codes into our EMR system in the following order: 31296, 61782, 31295, 31297, and any other procedures our ENT may have performed but Medicare still denies payment stating the code cannot be billed separately. Any insight in how we can get Medicare to cover this code? Thanks!
SuperCoder Posted 6 month(s) ago
Do not code 61782 unless the guidance is medically necessary and appropriately documented in the operative note. To report this, your documentation should include at least one of these reasons:
- Disease abutting the skull base, orbit, optic nerve or carotid artery
- Cerebrospinal fluid rhinorrhea or conditions where there is a skull-base defect
- Benign and malignant sino-nasal neoplasms
- Revision sinus surgery
- Distorted sinus anatomy of development, postoperative, or traumatic origin
- Extensive sino-nasal polyposis
- Pathology involving the complex posterior ethmoid, frontal and sphenoid sinuses
- Seal Your Claim With Appropriate Diagnosis Links
Make sure you have good documentation for medical necessity and the use of the stereotactic guidance is adequately documented, because now, in the appeal process, you are going to have your documentation under a microscope. You always need medical necessity and demonstration of the use of stereotactic guidance whether the op note is going to be reviewed.
If you are having continued problems getting +61782 paid with medically necessary sinus surgeries, contact the Practice Management Department of the American Academy of Otolaryngology/Head and Neck Surgery and notify them with copies of the remittance advices so that they can address this problem as an Academy.
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