CODING SA Soc ORL-HNS Conference Johannesburg

Transcription

1 CODING 2016 SA Soc ORL-HNS Conference Johannesburg

2 Coding: What you need to know CODES COMMENTS COMMENTS New Codes Tiered Codes Discharge Code Rule G Strobe and Flexible Scope STR / NSR Cosmetic vs Functional Unbundling Guidelines

3 Coding: What you need to know CODES COMMENTS COMMENTS New Codes 2016: not all funds Can use old codes Tiered Codes Can use same fee 0193 not recognised Discharge Code 0176 < 30 mins 0177 > 30 mins Rule G 30 days (10 for grommets) Routine cases 0 for scopes / trachy Comorbid not routine Strobe and Flexible Scope Reject repeated use avoid STR / NSR Cosmetic vs Functional 1085 = Cosmetic clearly identified Unbundling Check Descriptors Medical advisors may be wrong Guidelines Funds refer to SAMA often Challenge ? Funds don t follow SAMA tiers nor equal rand unit value for ops and consults

4 Descriptors and Guidelines 1036 Endoscopic ethmoid surgery: Bilateral 245 This item applies to surgery of the ethmoids only and may be combined with the items for surgery to the frontal, antral and sphenoid sinuses and/or surgery to the septum, turbinates and external nose (modifier 0005 applies) Modifier 0069 Endoscopic instruments add 10% of the fee of the procedure 4892 Endoscopy: Sinus/nasal, with partial, anterior ethmoidectomy 73.4 This item may not be combined with 1035 (ipsilateral) nor 1036 Modifier 0069 Endoscopic instruments add 10% of the fee of the procedure This item may be combined with 1035 when performed on contralateral side Current codes used: 1036 (for bilateral), 1035 (for unilateral) 1033 Removal of multiple polyps in hospital under general anaesthetic 90 Item Removal of multiple polyps in hospital under general anaesthetic (unilateral), may not be charged routinely in conjunction with item 1035 nor item 1036 nor other sino-nasal items. Item may be used in conjunction with item1035 and item 1036 and other sino-nasal items for cases with significant polyposis. Modifier 0005 is applicable Modifier Endoscopic instruments add 10% of the fee of the procedure

5 1105 Removal of adenoids <12 40 Modifier 0005 is applicable to item Instrumental examination of the nasopharynx including biopsy under general anaesthetic, when used in conjunction with adenoidectomy (item 1105) Modifier 0005 is applicable if a tonsillectomy and an adenoidectomy are performed at the same session Diathermy to nose or pharynx item 1039 may not be used routinely in conjunction with item 1105 Item 1039 may be used for excessive bleeding or adenoid remnant cautery Use item 1105 for >12 (new code not accepted). Recommend 55.5 units

6 ENT 80% Basket (Change Units only to match CPT4 relativity) CODE DESCRIPTOR CROSSWALK CPT4 RVU CURRENT UNITS 2016 UNITS AT 10X CHANGE (DECREASE) 1069 PROOF PUNCTURE (3.4) (9.7%) 1052 INSTRUMENTAL EXAMINATION NASOPHARYNX (9.5) (19%) 1030 ENDOSCOPIC TURBINECTOMY LASER OR MICRODEBRIDER (32.2) (35.7%) 3245 FUNCTIONAL RECONSTRUCTION (6.5) (2.3%) TYMPANIC MEMBRANE 1101 TONSILLECTOMY <12YRS (<12yrs) % 1105 ADENOIDECTOMY <12YRS % 1087 SUBTOTAL RECONSTRUCTION % 1022 FUNCTIONAL RECONSTRUCTION % NASAL SEPTUM 3237 EXPLORATORY TYMPANOTOMY %

7 Confirmation MedCodeLink, Dalena Coetzee 2016 RVUs < 2014 RVUs CODE DESCRIPTOR CROSSWALK CPT4 RVU 2014 RVU DPP (sinus washout) PNS (post nasal )EXAM ENDOSCOPIC TURBINECTOMY FUNCTIONAL RECONSTRUCTION TYMPANIC MEMBRANE TONSILLECTOMY <12YRS 42825<12yrs ADENOIDECTOMY <12YRS SUBTOTAL RECONSTRUCTION SEPTUM RECONSTRUCTION EXPLORATORY TYMPANOTOMY

8 New code Sphenopalatine artery ligation/cautery CODE DESCRIPTOR CROSSWALK RVU CURRENT 2016 UNITS AT CHANGE CCSA 2016 CPT4 UNITS 10X NEW CODE SPHENOPALATINE ARTERY LIGATION/CAUTERY N/A N/A 4.87