Instrumentation – MedicalCodingNews.Org

Accessory Sinuses Service Coding: Snag $217 with These 3 FAQs

Given the variety of anatomic sites, surgical techniques, and types of instrumentation involved in transnasal turbinate surgery, it is the one of the most difficult coding scenarios.

Your otolaryngologist removes the middle turbinate during an endoscopic ethmoidectomy (31254, Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial [anterior], or 31255, Nasal/sinus endoscopy, surgical; with ethmoidectomy, total [anterior and posterior]) or endoscopic polypectomy (31237, Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement [separate procedure]). The middle turbinates are considered access to the sinuses, so you should be able to tell that the removal of the middle turbinate should not be reported separately.

Check out these 3 frequently asked questions (FAQs) to help master your turbinate surgery coding skills.

Should 30130 and 30140 Go Hand-in-Hand?

Suppose the documentation states that the physician entered or excised mucosa and subsequently preserved it. This implies that you should use 30140 (Submucous resection inferior turbinate, partial or complete, any method) to report this service. However, simply reporting that the turbinate was excised is probably not enough documentation for this code. Don’t forget to bill 30130 (Excision inferior turbinate, partial or complete, any method) if there is no evidence of the preservation of the mucosa and the op note just indicates that the inferior turbinate was excised or resected.

Remember that you should not bill 30140 with 30130 — you would bill one or the other, for a single side. “However, if a submucousal resection (preservation of the mucosa) is performed on one side and a straight excision is performed on the other side (no preservation of mucosa), you would code 30140-RT and 30130-59-LT, for example,” explains Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J. The RT and LT would represent which side each procedure...

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April 5, 2011

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Simplify Ear Coding With These Expert Tips

With more patients turning in for a variety of ear conditions, you cannot afford to lose any reimbursement. Look to our expert advice to ensure you’re coding correctly for all of the ear associated diagnoses.

1. Verify Documentation for E/M With 69210

Cerumen removal can present several coding challenges for your practice, particularly if the physician performs the service as a gateway to visualize the ear. Knowing when you can report 69210 (Removal impacted cerumen [separate procedure], 1 or both ears) is key to collecting for this service.

Example: Suppose a patient presents with ear pain, but the physician has to remove impacted cerumen before he can visualize the tympanic membrane. He subsequently diagnoses an ear infection. Your practice wants to bill an office visit and modifier along with 69210 – is that acceptable?

Key: “Whether to report 69210 is always a value judgment because if you just flick a little wax aside to visualize the eardrum, you shouldn’t bill for cerumen removal,” says Charles Scott, MD, FAAP, with Advocare Medford Pediatric and Adolescent Medicine in New Jersey. “Typically, I’ll use that code if I have to use a special device that allows me to curette the ear before I can visualize the tympanic membrane,” he advises.

The July 2005 CPT Assistant states that cerumen is considered “impacted” in several circumstances, one of which is, “cerumen impairs exam of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition.” Therefore, if the cerumen is blocking the physician’s view and he has to use special instrumentation to remove it above and beyond irrigation, most payers allow you to report 69210.

You should ensure that you have separate documentation of the E/M service and procedure to support reporting both codes. Some practices overuse 69210, which means many...

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December 15, 2010

Hot Coding Topics

Wound Coding: 3 Tips Help You Recover Your Full Debridement Pay

Maximize 11040-11044 pay with modifier 51.

In most cases, your practice won’t report debridement separate from wound repair codes. But when exceptions arise, follow these three tips to choose the appropriate wound repair code.

If you’re considering reporting debridement separate from a wound closure, make sure your physician’s notes clearly document that the wound was contaminated and required saline or other substances or instrumentation to cleanse and debride the wound.

Don’t miss: If you report a debridement code with your wound closure codes, append modifier 59 (Distinct procedural service) to the debridement code. This informs the payer that you recognize that debridement is generally bundled into wound repair, but that clinical circumstances required the physician to perform debridement as a separate service.

1. Look for Wound Repair With the Debridement

CPT specifies that you may also report debridement codes independently of repair codes when the physician removes large amounts of devitalized or contaminated tissue or when the physician performs debridement without immediate primary repair of a wound, notes Pamela Biffle, CPC, CPC-I, CCS-P, CHCC, CHCO, owner of PB Healthcare Consulting and Education Inc. in Watauga, Texas.

The physician may clean debris from the wound without repairing the wound because it was either not deep enough to require repair or the physician delayed the repair due to an extenuating circumstance.

In the case in which the dermatologist excises a lesion, debridement is included in the procedure. However, when the dermatologist only performs debridement or performs the debridement in addition to the wound repair, such as the case when a wound is excessively dirty or contaminated with debris, you would also code the debridement code with the wound repair/excision code, appending modifier 51 (Multiple procedures) for the multiple procedure.

Example: A patient returns to the dermatologist several days after a chemical...

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June 13, 2010