Hot Coding Topics

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
Hot Coding Topics / ICD-10 / Provider News

ICD-10: A J Code To Replace 471.0 In 2013

Nasal cavity polyp also goes by the term “choanal” and “nasopharyngeal.” If the otolaryngologist performed a removal of a middle turbinate endoscopically, you would report it with CPT 31240 — subsequently linking this procedure to a diagnosis...

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March 16, 2011
Hot Coding Topics / ICD-10

Ensure Compliance With ICD-10 With These 3 Tips

When ICD-9 becomes ICD-10 in 2013, you will not always have a simple crosswalk relationship between old codes and the new ones. Often, you’ll have more options that may require tweaking the way you document services and a coder reports it. Check out the following examples of how ICD-10 will change your coding options when the calendar turns to Oct. 1, 2013.

Celebrate Sinusitis Codes’ One-to-One Relationship for ICD-10

When your physician treats a patient for sinusitis, you should report the appropriate sinusitis code for sinus membrane lining inflammation. Use 461.x for acute sinusitis. For chronic sinusitis — frequent or persistent infections lasting more than three months — assign 473.x.

For both acute and chronic conditions, you’ll choose the fourth digit code based on where the sinusitis occurs. For example, for ethmoidal chronic sinusitis, you should report (473.2, Chronic sinusitis; ethmoidal). Your otolaryngologist will most likely prescribe a decongestant, pain reliever or antibiotics to treat sinusitis.

ICD-10 difference: Good news. These sinusitis options have a one-to-one match with upcoming ICD-10 codes. For acute sinusitis diagnoses, you’ll look at the J01.-0 codes. For instance, 461.0 (Acute maxillary sinusitis) translates to J01.00 (Acute maxillary sinusitis, unspecified). Code 461.1 (Acute frontal sinusitis) maps directly to J01.10 (Acute frontal sinusitis). Notice how the definitions are mostly identical. Like ICD-9, the fourth digit changes to specify location.

For chronic sinusitis diagnoses, you’ll look to the J32.- codes. For instance, in the example above, 473.2 maps direction to J32.2 (Chronic ethmoidal sinusitis). Again, this is a direct one-to-one ratio with identical definitions. Like ICD-9, the fourth digit changes to specify location.

Physician documentation: Currently, the physician should pinpoint the location of the sinusitis. This won’t change in 2013.

However, you’ll scrap the 461.x and 473.x options and turn to J01.-0 and J32.- in your ICD-10...

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March 1, 2011
Hot Coding Topics / modifier 59 / NCCI

NCCI Edits: Watch Out For These Endoscopy Bundles

Code 31575 includes 92511 and 31231 except under these conditions.

Singling out the correct endoscopy code when your otolaryngologist examines multiple areas in the sinuses and throat isn’t always easy, but in most cases it’s imperative to settle on one, according to National Correct Coding Initiative (CCI) edits. You can adhere to these edits and avoid payback requests if you stick to these guidelines.

3 Rules Guide the Way

Rule #1: Never report 92511 (Nasopharyngoscopy with endoscope[separate procedure]) and 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) together, says Stephen R. Levinson, MD, otolaryngologist and coding consultant based in Easton, Conn. Code 92511 is a component of Column 1 code 31231. The bundle has a modifier indicator of “0” — thus, no modifier can break this bundle.

Rule #2: Code 92511 is a component of Column 1 code 31575 (Laryngoscopy, flexible fiberoptic; diagnostic) but a modifier is allowed in order to differentiate between the services provided (that is, you may append modifier 59 [Distinct procedural services] if there are separate and identifiable services with separate medical indications). Report 92511 in conjunction with 31575 for the same encounter, says Levinson, only if the following conditions are met:

  • there are separate medical indications for examining each area (for instance, 784.49 for hoarseness with 31575 in an adult patient with a hyperactive gag reflex and 381.4 for a unilateral or bilateral middle ear effusion with 92511, which would be a rare occurrence), and
  • the ENT uses a different scope for each, separate procedure because there is a documented reason that the fiberoptic scope did not provide adequate visualization of the nasopharynx. “This would be highly unlikely,” emphasizes Levinson.

Rule #3: Code 31231 is a component of Column 1 code 31575 but a modifier is allowed in order...

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June 1, 2010
Hot Coding Topics

3 Coding Options Resolve Balloon Sinuplasty Questions

Your solo dilation coding will get easier come 2011.

With no dedicated code for a balloon sinuplasty, you’re not alone if you’ve wondered how to code endoscopic sinus surgery involving the newer tool.

You, however, can confidently navigate to the...

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April 26, 2010