Otolaryngology Coding Alert

Distinguish between these two types of hearing aid devices.

Effective January 1, 2019, HCPCS has incorporated a new set of otolaryngology-specific codes for your practice to consider. Among the most important changes, you’ll find that HCPCS introduced a brand-new set of contralateral routing of signal (CROS) and bilateral routing of signal (BiCROS) hearing aid codes.

Additionally, HCPCS incorporated a few worthwhile revisions and deletions to existing hearing aid codes. While hearing aids encompass the majority of ENT-related changes to the 2019 HCPCS manual, you’ll also want to consider a new bronchoscopy and benralizumab injection code.

Set your sights below for a list of all the most important HCPCS changes that you need to know.

Make Room for 9 New CROS, BiCROS Hearing Aid Codes

HCPCS introduced the following nine new codes that providers will now use to report CROS and BiCROS hearing aids:

• V5171 — Hearing aid, contralateral routing device, monaural, in the ear (ite)
• V5172 — …in the canal (itc)
• V5181 — …behind the ear (bte)
• V5211 — Hearing aid, contralateral routing system, binaural, ite/ite
• V5212 — …ite/itc
• V5213 — …ite/bte
• V5214 — …itc/itc
• V5215 — …itc/bte
• V5221 — …bte/bte.

Refresher: CROS amplification systems are typically designed for individuals with single-sided deafness (SSD). BiCROS amplification systems are designed for individuals with bilateral hearing loss, with one side less affected than the other. Current HCPCS reporting for these services does not accurately describe the wide range of clinical applications in which providers may configure these devices.

As you can see, CROS and BiCROS configurations are now differentiated by laterality and site. With respect to BiCROS configurations, providers can choose to apply the devices under a variety of different configurations previously non-reportable in the HCPCS manual. In addition to these new codes, you’ll want to consider some subtle alterations to four existing CROS and BiCROS hearing aid configurations:

• V5190 — Hearing aid, contralateral routing, monaural, glasses
• V5200 — Dispensing fee, contralateral, monaural
• V5230 — Hearing aid, contralateral routing system, binaural, glasses
• V5240 — Dispensing fee, contralateral routing system, binaural.

Comparing these codes to their 2018 descriptions, you can see that HCPCS adds an extra degree of specificity to CROS and BiCROS hearing aids configured to a patient’s glasses. Finally, make yourself aware of these four deleted CROS and BiCROS hearing aid codes:

• V5170 — Hearing aid, cros, in the ear
• V5180 — Hearing aid, cros, behind the ear
• V5210 — Hearing aid, bicros, in the ear
• V5220 — Hearing aid, bicros, behind the ear.

You may now use one of the nine new, more specific, HCPCS codes in place of these four deleted codes.

Consider 2 New Codes for Bronchosopy, Benralizumab Injection

In addition to hearing aid devices, there are two additional new HCPCS codes individuals working within an otolaryngology practice and/or outpatient facility will want to consider. First, have a look at this new HCPCS code providers should use to report a bronchoscopy with transbronchial ablation of lesion(s) by microwave energy:

• C9751 — Bronchoscopy, rigid or flexible, transbronchial ablation of lesion(s) by microwave energy, including fluoroscopic guidance, when performed, with computed tomography acquisition(s) and 3-d rendering, computer-assisted, image-guided navigation, and endobronchial ultrasound (ebus) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]) and all mediastinal and/or hilar lymph node stations or structures and therapeutic intervention(s).

Caution: “Code C9751 is a HCPCS code that should only be reported by outpatient facilities,” says Jennifer M. Connell, CPC, COC, CENTC, CPCO, CPMA, CPPM, CPC-P, CPB, CPC-I, CEMA, owner of E2E Health Solutions in Victoria, Texas. “C codes such as this were created by Medicare and are reimbursed under the Outpatient Prospective Payment System (OPPS), not the physician fee schedule,” Connell explains.

Finally, amidst the assortment of new injection codes HCPCS has to offer in 2019, there’s one that you may find useful in your ENT practice:

• J0517 — Injection, benralizumab, 1 mg (asthma)

If your provider performs an injection of benralizumab for patients with asthma, you will report drug code J0517. For outpatient facility coders, you should report this service separately under code C9466 (Injection, benralizumab, 1 mg). “Remember that a physician can code and bill for a J code,” says Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO, AAPC Fellow, of CRN Healthcare in Tinton Falls, New Jersey. “Whereas a physician cannot code nor bill a C code, which is reserved as a pass through for facilities,” Cobuzzi explains.