2017 Coding and Reimbursement Survival Guide

Transcription

1 2017 Coding and Reimbursement Survival Guide Chapter 14: Otolaryngology CPT 2017: Latest CPT Edition Offers New Code for Injection Laryngoplasty Changes could impact your reimbursement. The New Year is just around the corner, and what better way to prepare for 2017 than to learn the new codes that will impact your ENT practice? Caution: These updates are based on the preliminary list of code adjustments, and changes may occur before the code set is final. Keep checking back in to Otolaryngology Coding Alert for news about the final codes and details on proper use of your updated options. Finally A Way to Code Injection Laryngoplasty Otolaryngologists have been performing a procedure known as injection laryngoplasty with increasing frequency. They inject material into the larynx to move the vocal cords over to center in patients with vocal cord paralysis and stenosis. They do it with the patient awake, either in the office or in the operating room. In some cases, the doctor will use Electromyography (EMG) for additional guidance. CPT 2017 will include a new code for the procedure, which falls within the newly-expanded laryngoplasty section of CPT, which includes recently-debuted codes, as follows: You ll report for injection laryngoplasty effective Jan. 1. Previously, you reported (Laryngoscopy, direct, with injection into vocal cord[s], therapeutic), (Laryngoscopy, direct, with injection into vocal cord[s], therapeutic; with operating microscope or telescope), or (Unlisted procedure, larynx) and then appealed on denial fortunately, those problems should be eliminated thanks to CPT s debut of the new code. It s unclear whether new code will replaced (Chemodenervation of muscle(s); larynx, unilateral, percutaneous [eg, for spasmodic dysphonia], includes guidance by needle electromyography, when performed) if the doctor uses a scope when administering chemodenervation such as botox. Currently, percutaneous botox administration is coded with 64617, whereas endoscopically transoral injected botox is coded with and New code will likely allow coders to report laser destruction of lesions more accurately. Currently, ENT practices use (Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis) or (Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with operating microscope or telescope) for these services. Look for New Codes Covering Open Laryngoplasty You ll also find a significant number of new codes describing open laryngoplasty, which should help you get more specific

2 in In addition, some codes were revised, which are marked with new text underlined. The new, deleted, and revised codes in this category are as follows: It s unclear what type of relative value units CMS will assign to these new and revised codes, but keep your eye on future issues of Otolaryngology Coding Alert as the news develops. ICD-10 QUIZ: Evaluate Your ICD-10 Know-How With This Quick Quiz These ENT-specific scenarios will help you gauge your knowledge. You ve been reporting ICD-10 codes for over a year now, and your success rate probably grows with each claim. To ensure that you ve got a handle on the correct diagnosis codes to report, take this short quiz, and then check your answers to ensure you ve coded properly. Get the Scoop on Tonsillitis Coding Question: Which diagnosis code should you report for acute tonsillitis? Answer: Acute tonsillitis might be one of the most common diagnoses your otolaryngologist assigns, and one of the easiest for you to code. Although you only had one code to consider under ICD-10, you ve had to expand your horizons since ICD-10 wants to know the type of the patient s tonsillitis. The fourth character in your tonsillitis code will identify the organism and the fifth will indicate whether the patient s condition is acute or recurrent, as follows: J03.0 Streptococcal tonsillitis J03.00 Acute streptococcal tonsillitis, unspecified J03.01 Acute recurrent streptococcal tonsillitis J03.8 Acute tonsillitis due to other specified organisms J03.80 Acute tonsillitis due to other specified organisms J03.81 Acute recurrent tonsillitis due to other specified organisms

3 J03.9 Acute tonsillitis, unspecified (which includes follicular tonsillitis [acute], gangrenous tonsillitis [acute], infective tonsillitis [acute], tonsillitis [acute] NOS, and ulcerative tonsillitis [acute]) J03.90 Acute tonsillitis, unspecified J03.91 Acute recurrent tonsillitis, unspecified A patient that has acute tonsillitis that is not recurrent is assigned an unspecified diagnosis. This does not mean that the diagnosis is truly unspecified in these cases. This unspecified diagnosis actually means that the patient s acute tonsillitis is not mentioned as recurrent. Payers should not penalize providers for using these unspecified diagnoses since there are no other alternatives available. Extract Appropriate Cerumen Impaction Dx Question: How do you report impacted cerumen? Answer: You ll find your choices in the H61.2- (Impacted cerumen) series of codes. The fourth digit will specify the affected ear: H61.20, Impacted cerumen, unspecified ear H61.21, Impacted cerumen, right ear H61.22, Impacted cerumen, left ear H61.23, Impacted cerumen, bilateral. You ll want to report the unspecified ear code H61.20 as seldom as possible. The reality is that your physician should be documenting the affected ear for every patient and the unspecified ear diagnosis should not ever be used. Evaluate the Hearing Loss Options Question: Which code should you report for mixed hearing loss? Answer: Last year, ICD-10 debuted new codes for mixed hearing loss, as the original iteration of ICD-10 did not include them, and coders were forced to report unspecified codes. The correct codes for mixed hearing loss are in the H90.A3 category (Mixed conductive and sensorineural hearing loss, unilateral with restricted hearing on the contralateral side). To identify the affected ear, you ll select a sixth character as follows: H90.A31 Mixed conductive and sensorineural hearing loss, unilateral, right ear with restricted hearing on the contralateral side H90.A32 Mixed conductive and sensorineural hearing loss, unilateral, left ear with restricted hearing on the contralateral side. Get the Right Code for Drainage of a Nasal Abscess Question: A provider aspirates the excess fluid from an abscess within the nasal cavity. How do we report this procedure? Answer: You could report (Drainage abscess or hematoma, nasal, internal approach). In this procedure, the provider aspirates the excess fluid from within the nasal cavity, which may be due to an abscess or hematoma. The provider makes a small incision within the nasal mucosa over the abscess or hematoma, suctions and flushes the fluid filled pocket with sterile saline. After he achieves hemostasis, he may secure a drain and then he closes the operative site in layers. However, if the provider uses an external approach, report (Incision and drainage of abscess [eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; simple or single) for a simple incision and drainage of an abscess that is situated just below the skin s surface, or (Incision and drainage of hematoma, seroma or fluid collection) when the provider makes an incision into the hematoma, seroma, or other collection of fluids and bluntly penetrates it to allow fluid evacuation.

4 Each of these procedures carries a 10-day postoperative period, which means that all procedure-related care for 10 days after the procedure is not separately billable. Modifiers: Brush Up on When 62 Fits for Co-Surgery Be sure to match both surgeons codes. Otolaryngologists sometimes perform surgeries with other specialists, such as when they re asked to take a biopsy, remove a tumor, or resect a portion of the pituitary gland. But does that mean you automatically append modifier 62 (Two surgeons) to your claim? The answer depends on each surgeon s role during the encounter, the specific procedures performed and how they document the service. Pay Attention to Indicators Check your Medicare physician fee schedule database to confirm that the procedure you wish to report qualifies for modifier 62. Otherwise, your surgeons cannot code and bill as co-surgeons for that procedure. To be eligible for payment, make sure that your procedure codes have either a Medicare co-surgery indicator of 1 or 2. Remember their meanings: If you find a code carries a co-surgery indicator of "1," you must supply documentation to establish medical necessity for two surgeons. Present which circumstances in the procedure requires special skills or expertise by two surgeons sharing a responsibility. A "2" in the co-surgery column indicator means that you may append modifier 62 as long as each of the operating surgeons is of a different specialty. The AMA has a distinct descriptor of the modifier, stating that "each surgeon should report his/her distinct operative work by adding the modifier 62 to the single definitive procedure code." In short, modifier 62 applies for only one primary procedure and its related add-on codes for each surgeon. Medicare will not allow modifier 62 for a procedure with a "0" indicator, which means that you are not allowed to bill for cosurgeons. The same holds true for procedures with 9 in the co-surgery column. Medicare will not consider modifier 62 for these codes, so don t even attempt to append it. Example: Code (Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy) contains a 0 in the co surgery column. Thus, you will never be able to report modifier 62 with this code should an otolaryngologist and ophthalmologist perform the procedure together. Get Matching Surgical Documentation Co-surgeries billed with modifier 62 usually pay at 125 percent of the rate in the physician fee schedule, which is then split in two by the payer so that each provider receives 62.5 percent of the total fee. To bill this service as co-surgeons, the physicians must dictate separate operative reports describing their specific roles. Each op note is different and the addition of the two operative notes contents add up to equal the description of completing the co-surgery. Neither operative note alone describes the service and CPT code. And both practices should communicate to make sure each surgeon uses the same CPT code and the 62 modifier. The same diagnosis code(s) would also have to be used, and the documentation of both surgeons must state that they were co-surgeons for the procedure. Know When 62 Does Not Apply When a patient s condition requires the talents of two different surgical specialties, but each surgeon performs entirely separate procedures, you do not need to include a modifier such as 62. That s because even if the task performed by the otolaryngologist is similar to that performed by the other surgeon, each physician submits the distinct code that describes what he or she did. There is no penalty or reduction in the value for a surgery if one surgeon opens and the other closes or vice versa. CMS considers this trivial and does not require the use of the 52 modifier when the surgeon did not perform both the open and closure.

5 Note: The CMS fee schedule does not allow the co-surgeon modifier with many procedures. Private payers who do not follow CMS s fee schedule may not publish their own lists of procedures that do or do not permit co-surgery. Because of this, always check with the payer prior to the surgery or be prepared to appeal. ICD-10: Keep Your Epistaxis Coding Simple With a Single ICD-10 Choice Remember you still have multiple procedure codes associated with diagnosis. Epistaxis commonly known as nosebleed occurs when there is acute hemorrhage from the nostril, nasal cavity, or nasopharynx. When you still coded following ICD-9, you would report (Epistaxis) for nosebleed. You would also use the same code to report hemorrhage from the nose or bleeding from the nose. Now that you use ICD-10, you still have only a single code for an epistaxis diagnosis: R04.0. Documentation: If the patient presents with nosebleed, you should be on the lookout for encounter specifics in order to report the appropriate procedure codes. Terms like hemostasis (control of bleeding), Bovie, silver nitrate, and chemical cauterization on your physician s notes will give you a clue on how to tackle a nosebleed treatment encounter. Coder tips: To choose the appropriate epistaxis treatment code, first look at the bleed site: anterior or posterior. You have two code choices for each site: Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method Control nasal hemorrhage, anterior, complex (extensive cautery and/or packing) any method Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; initial subsequent. Also keep a check on coding edits for procedures that are bundled and not billable together. If a patient suffers from nasal hemorrhage postoperative, you would not report R04.0. Instead you should use T88.8XXA (Other specified complications of surgical and medical care, not elsewhere classified, initial encounter) because you would be reporting postoperative complications. - Published on