# Coding help needed urgently



## aknierieme (May 5, 2010)

Can somebody please help me with these coding cases?
I'm totally new to ENT, I have only billed for OBGYN and GI, please help.

1.  Bilateral maxillary antrostomy with removal of tissue, Right anterior ethmoidectomy, bilateral frontal sinusotomy, Left sphenoidotomy, Computer navigation (stereotactic guidance).

Would I bill 31267 mod 50, 31254, 31276 mod 50, 31287 ???
Is 31276 excluding 31287? What about mod 59 use needed?
How do I code for stereotactic guidance?

2. Functional Septorhinoplasty with septal cartilage and ear graft, bilateral inferior turbinate submucous resection and out fracture.
CPT 30520 ? Do I use mod 50? I can't bill 30140 in addition correct?

3.ER consult for foreign body.  Pt seen and evaluated with fiberoptic scope and determined to be taken to OR.  She undergoes the following procedures in the OR under general anesthesia after 6 hours: 1. Direct rigid laryngoscopy, 2. Rigid cervical esophagoscopy with removal of a 5cm x 10cm razor blade.  She is then admitted by doctor to the ICU and care is then transferred to the ICU physicians.  Physician sees the patient on POD#1 in the ICU and discharge her to home on POD#2.

99254 - ER consult correct ?
surgery 31575 or 31579?, how to code rigid cervical espohagoscopy?
99231
99233

4. Case no. 4:  Pt is seen and evaluated by doctor in the ER (no procedures done) and decision is made to repair complex facial lacerations in the OR.  He then undergoes multi-layer repair of a through and through laceration involving his left nasal pyramid skin which extends to the columella (bone is exposed) and all the way to the contralateral upper lip (see teeth).

99254
How to code the procedure?

Thanks so much for your help
Angie


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## Candice_Fenildo (May 5, 2010)

Hi Angie, Here goes 

1. Bilateral maxillary antrostomy with removal of tissue, Right anterior ethmoidectomy, bilateral frontal sinusotomy, Left sphenoidotomy, Computer navigation (stereotactic guidance).

31267 For the Bilateral Maxillary Antrostomy with Tissue Removal. and dont forget for -50 modifier. 
31254 for the right anterior ethmoidectomy. 
31276 for the Bilateral Frontals "if" tissue was removed
31288 for the sphenoids
61795 for the Navigation Steriotactic Guidance

Would I bill 31267 mod 50, 31254, 31276 mod 50, 31287 ???
Is 31276 excluding 31287? What about mod 59 use needed?
How do I code for stereotactic guidance?
you do not need the -59 modifier 31287 and 31276 are seperates sites

2. Functional Septorhinoplasty with septal cartilage and ear graft, bilateral inferior turbinate submucous resection and out fracture.
CPT 30520 ? Do I use mod 50? I can't bill 30140 in addition correct?
CPT code 30520 is for a septoplasty. there is only "one" Septum.  

3.ER consult for foreign body. Pt seen and evaluated with fiberoptic scope and determined to be taken to OR. She undergoes the following procedures in the OR under general anesthesia after 6 hours: 1. Direct rigid laryngoscopy, 2. Rigid cervical esophagoscopy with removal of a 5cm x 10cm razor blade. She is then admitted by doctor to the ICU and care is then transferred to the ICU physicians. Physician sees the patient on POD#1 in the ICU and discharge her to home on POD#2.

99254 - ER consult correct ? No 9928x for the ER consult
surgery 31575 or 31579?, how to code rigid cervical espohagoscopy? 43200 31575 for the scope. no video was used 
99231
99233

4. Case no. 4: Pt is seen and evaluated by doctor in the ER (no procedures done) and decision is made to repair complex facial lacerations in the OR. He then undergoes multi-layer repair of a through and through laceration involving his left nasal pyramid skin which extends to the columella (bone is exposed) and all the way to the contralateral upper lip (see teeth). need a little more deatils. size ?

99254
How to code the procedure?

feel free to call me. I have been coding ENT for 6 years and have ALOT of great articles for you


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## FTessaBartels (May 5, 2010)

*Consult vs ER*

Re case # 3.

If the patient is covered by Medicare (or a carrier who has decided to follow Medicare rules on not recognizing consults) you will code the documented level of ER visit 9928x

If the patient is NOT covered by Meciare (or a carrier who is following Meciare rules re consults) you will bill the documented OUTPATIENT consultation code 9924x  ...  *UNLESS* you are admitting the patient ... then, regardless of whether Medicare or not you would code the documented level of admission / initial visit.

As for the POD # 2 ... if the patient was admitted to your service and the procedure does NOT have a global period (I'm at home without my books right now) ... then I would use the documented discharge code (depending on whether patient was admitted as inpatient or observation/short stay).

Hope that helps.

F Tessa Bartels, CPC, CEMC


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