Maria Posted Fri 06th of December, 2019 14:19:38 PM
We are an ENT Practice. Can you please tell me how you would code this operative procedure? Nasal endoscopy with inferior turbinate outfracture and resection of nasopharyngeal tumor. The patient has a hyalinizing clear cell carcinoma of the nasopharynx. Thank you.
SuperCoder Answered Mon 09th of December, 2019 04:54:39 AM
In this scenario, usually, CPT 42808 (Excision or destruction of lesion of pharynx, any method) is used for the excision and 31231 for the nasal endoscopy. There is not a code for an endoscopic excision of a nasopharynx mass, so these codes are reported to bill this type of procedure. However, CPT 42808 is not appropriate to bill in this situation.
The other way to bill the procedure is to append modifier 22 (Increased procedural Services) with nasal endoscopy, i.e. 31231 or code the procedure with unlisted code of nose, i.e. 30999.
In order to append modifier 22 to a surgical procedure, check that the physician documented the reason(s) why the work he performed was more than he typically performs, and the documentation should include any or all of the following:
- Increased intensity
- Additional time
- Technical difficulty
- Severe patient condition, which causes the surgery to be difficult, dangerous to the patient, and requires additional physical and mental effort from the physician
Also, when reporting a procedure with an unlisted code, submit a cover letter explaining the reason for choosing the unlisted code instead of a defined, active code. Also include the operative notes or other relevant documentation to strengthen the claim and to avoid a possible denial. Your payers will consider claims with unlisted procedure codes on a case by case basis, and they will determine payment based on the documentation you provide.
Hope this helps!
Maria Posted Mon 09th of December, 2019 16:42:55 PM
Thank you. I appreciate your help. I will share this information with the doctor.
SuperCoder Answered Mon 09th of December, 2019 23:55:08 PM
Thank you, happy to help.