2012 Head and Neck Reconstruction/ENT Repair Coding Observations
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- Jocelin Cobb
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1 Health Policy, Economics & Reimbursement Reimbursement Hotline Tel: Fax: Head and Neck Reconstruction/ENT Repair Coding Observations CPT Codes & Descriptors Relative Value Units [RVUs] Non / Physician Non / Hospital Outpatient Ambulatory Surgery Center [ASC] Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; total wound surface area up to 100 sq cm or less, first 25 sq cm or less wound surface area Each additional 25 sq cm wound surface area, or part thereof [List separately in addition to code for primary procedure] 4.24/2.58 $154.87/ $ /0.73 $33.70/ $24.85 $ $ $ $ Implantation of biologic implant [e.g., acellular dermal matrix] for soft tissue reinforcement [e.g., breast, trunk] 6.29 $ $1, $ HCPCS Codes & Descriptors Q 4112 Q 4116 Cymetra, injectable, 1cc AlloDerm, per sq cm Revenue Codes & Descriptors 272 Medical/Surgical Supplies and Devices Sterile Supply 278 Medical/Surgical Supplies and Devices Other Implants [e.g., AlloDerm RTM and Cymetra Micronized AlloDerm Tissue (MAT)]
2 CPT Codes & Descriptors Relative Value Units [RVUs] Non / Physician Non / Hospital Outpatient Ambulatory Surgery Center [ASC] Nose Rhinoplasty, primary; including major septal repair Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip only Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft Repair nasal septal perforations $1, $3, $1, $ $3, $1, $ $1, $1, $ $1, $1, Larynx Layrngoplasty; cricoid split $1, Inpatient only Inpatient only Salivary Glands Laryngoplasty, not otherwise specified Laryngeal reinnervation by neuromuscular pedicle Plastic repair of salivary duct, sialodochoplasty; primary or simple Plastic repair of salivary duct, sialodochoplasty; secondary or complicated $1, $3, $1, $ $3, $1, /10.46 $451.68/$ $1, $1, /13.78 $577.96/$ $3, $1, Pharynx Limited pharyngectomy $1, $3, $1, Resection of lateral pharyngeal wall or pyriform sinus, direct closure by advancement of lateral and posterior pharyngeal walls Resection of pharyngeal wall requiring closure with myocutaneous flap $1, $3, $1, $2, Inpatient only Inpatient only
3 CPT Codes & Descriptors Relative Value Units [RVUs] Non / Physician Non / Hospital Outpatient Ambulatory Surgery Center [ASC] Middle Ear Transmastoid antrotomy [simple mastoidectomy] $ $3, $1, Mastoidectomy; complete $1, $1, $1, Mastoidectomy; modified radical Revision mastoidectomy; resulting in complete mastoidectomy Revision mastoidectomy; resulting in modified radical mastoidectomy Revision mastoidectomy; resulting in tympanoplasty Tympanoplasty with mastoidectomy; without ossicular chain reconstruction Tympanoplasty with mastoidectomy; with ossicular chain reconstruction Tympanoplasty with mastoidectomy; with intact or reconstructed wall, without ossicular chain reconstruction Tympanoplasty with mastoidectomy; with intact or reconstructed canal wall, with ossicular chain reconstruction Tympanoplasty with mastoidectomy; radical or complete, without ossicular chain reconstruction Tympanoplasty with mastoidectomy, radical or complete, with ossicular chain reconstruction Palate Palatoplasty for cleft palate, with closure of alveolar ridge; soft tissue only Palatoplasty for cleft palate, with closure of alveolar ridge; with bone graft to alveolar ridge Palatoplasty for cleft palate; major revision $1, $3, $1, $1, $3, $1, $1, $3, $1, $1, $3, $1, $1, $3, $1, $1, $3, $1, $1, $3, $1, $1, $3, $1, $1, $3, $1, $1, $3, $1, $ $3, $1, $1, $3, $1, $ $3, $1,817.30
4 ICD-9-CM Procedure Codes & Descriptors MS-DRG [series] Repair of blepharoptosis and lid retraction 115, 907, [series] Other reconstruction of eyelid 115, 579, 907, [series] Repair and plastic operations on the nose 133, [series] Repair of salivary gland or duct 139, [series] Excision of other parts of mouth 137, 579, [series] Plastic repair of mouth 133, 579, 907, [series] Palatoplasty 137, Plastic operation of pharynx 040, 041, 133, 907, [series] Other repair of pharynx 133, [series] Repair of blepharoptosis and lid retraction 115, 907, [series] Dermal Regenerative Skin [e.g., AlloDerm RTM] ICD-9-CM Diagnosis Codes & Descriptors Fracture nasal bones Bell s palsy Cleft palate and cleft lip Benign neoplasm of bone and articular cartilage, lower jaw bone Neoplasm of uncertain behavior of bone and articular cartilage Neoplasm of uncertain behavior of lip, oral cavity and pharynx Neoplasm of uncertain behavior, major salivary gland Ptosis of eyelid, unspecified Myogenic ptosis Mechanical ptosis Disease of lips Congenital deformities of eyelids Scar conditions and fibrosis of skin
5 Diagnostic Related Groups [DRGs] Codes & Descriptors 040 Peripheral/Cranial Nerve and Other Nervous System Procedures with major complications and comorbidities [MCC] Medicare National Average $21, Peripheral/Cranial Nerve and Other Nervous System Procedures with $11, complications and comorbidities [CC] or Peripheral Neurostimulator 115 Extraocular Procedures Except Orbit $ 6, Other Ear, Nose, Mouth and Throat O.R. Procedures with CC/MCC $ 8, Mouth Procedures with CC/MCC $ 6, Salivary Gland Procedures $ 4, Other Skin, Subcutaneous Tissue and Breast Procedures with MCC $14, Other Endocrine, Nutritional and Metabolic OR Procedures with MCC $16, Other O.R. Procedures for Injuries with MCC $20, Nonextensive O.R. Procedure Unrelated to Principal Diagnosis with MCC $17, Sources: EncoderPro for Payers, Professional 2011 [Ingenix] CPT is a registered trademark of the American Medical Association. Physician CPT rates reflect a conversion factor of $ as of January 9, Inpatient facility rates reflective of 2012 National Medicare Average s. Centers for Medicare & Medicaid Services. Federal Register notices, [CMS-1518-F; CMS-1518-CN3], August 18, 2011 and September 25, Outpatient facility rates reflective of 2012 National Medicare Average s. Centers for Medicare & Medicaid Services. Federal Register notice, [CMS FC ], November 30, Disclaimer: This has been prepared for providers using LifeCell TM products and intended for informational purposes only. It does not represent a guarantee, promise or statement by LifeCell Corporation concerning levels of reimbursement, payment or charges. It is not intended to increase or maximize reimbursement. The decision as to how to complete a claim form, including the amounts to bill, is exclusively the responsibility of the provider. Consult the LifeCell TM Reimbursement Hotline at or reimbursement@lifecell.com for additional information.
6 Reimbursement service available! AlloDerm Regenerative Tissue Matrix and Cymetra Micronized AlloDerm Tissue reimbursement questions? LifeCell Corporation s commitment to surgeons and facilities using AlloDerm RTM, AlloDerm RTU and Cymetra Micronized AlloDerm Tissue to treat patients includes a Case Management Hotline. The Hotline is staffed by credentialed nurses and professional medical coders to help with: Coverage Coding Reimbursement Denied claims Appeals support Case pre-certifications/pre-determinations LifeCell TM Reimbursement Hotline Monday to Friday 8:00 a.m. - 8:00 p.m. ET Tel: Fax: reimbursement@lifecell.com LifeCell Corporation One Millennium Way Branchburg, NJ Tel: Fax: LifeCell TM Customer Solutions LifeCell Corporation. All rights reserved. LifeCell TM, AlloDerm and Strattice TM are trademarks of LifeCell Corporation. MLC 2106-R2/1883/2-2012
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