Otolaryngology Coding Alert

Save over $50 with this nasal fracture repair secret

If you forget to report nose splints with nasal fracture repair procedures, you'll lose $58.75 in revenue.

Otolaryngologists, however, often omit this important detail from their chart notes. But, you can ethically maximize nasal fracture repair reimbursement if you follow these steps:

1. Look for Closed Versus Open

You should first focus on how your otolaryngologist treats the nasal fracture. He or she uses either closed or open repair.

Pitfall: Don't confuse the fracture type (ICD-9) with the treatment type (CPT). "The type of fracture, such as open, compound, or percutaneous, does not have any coding correlation with the type of treatment, closed or open," says Rhonda Buckholtz, CPC, practice manager at Crawford and Fitch -- Ear, Nose and Throat in Franklin, Pa.

Solution: Look at whether your otolaryngologist opens the fracture site. If he doesn't, you should use a closed treatment code (21310-21320), Buckholtz says. When he surgically opens the fractured bone or opens the bone remotely from the fracture site, you should assign an open repair code (21325-21330).

To pinpoint the exact repair code that you should report, you next have to determine the method the otolaryngologist uses.

2. Choose the Closed Method

If the otolaryngologist didn't surgically open the fracture site, you need to select the closed repair method. Otolaryngologists repair nasal fractures without opening the site with one of these three methods:

1. without manipulation
2. with manipulation
3. with or without traction.

Each method corresponds to a specific code. You should use 21310 (Closed treatment of nasal bone fracture without manipulation) for closed treatment of the nasal bone without manipulation (reduction), Buckholtz says. If the otolaryngologist reduces the fracture, but doesn't stabilize it, you should report 21315 (Closed treatment of nasal bone fracture; without stabilization). Make sure to use 21320 (... with stabilization) if the otolaryngologist stabilizes the fracture.

Tip: Otolaryngologists usually use a nose splint to stabilize a fracture. "Ninety-nine percent of the time our otolaryngologists perform 21320," says Dora A. Allen, CPC, coding coordinator for the three-otolaryngologist University Surgical Associates in Louisville, Ky.

Problem: Otolaryngologists often don't document using a nose splint. "They don't realize that there are separate codes for with and without stabilization," Allen says. Omitting the splint detail will cut $58.75 from the claim.

Illustration: An otolaryngologist documents "closed reduction of nasal bone fracture." In this case, you should report 21315 for the closed reduction or manipulation.

As you code the chart note, you think you recall that the patient required a nose splint. So, you ask the otolaryngologist about this detail. He says the patient did and adds an addendum, "Used nasal splint to stabilize fracture," to his note. Based on the added documentation, you should bill 21320, Allen says. Tracking down the detail, however, wastes valuable time.

Better way: Explain to your otolaryngologists that the only difference between 21315 and 21320 is using a nasal splint. Remembering to add this detail, when appropriate, to their notes will add $58.75 to their bottom line.

3. Identify Open Method

For open nasal fracture repairs, you should instead use 21325 or 21330. To determine the appropriate code, look at the otolaryngologist's method. He opens the fractured bone either surgically or remotely to insert an intra-medullary nail across the fracture site, Buckholtz says

If your otolaryngologist uses a nail, you should report 21330 for the fixation. For nasal bone fracture repairs that don't require fixation, you should report an uncomplicated open repair with 21325.

Example: A chart note states: I made an incision into the nasal bone area to repair a fracture.

Answer: You should report 21325 for the open nasal bone fracture repair.