Otolaryngology Coding Alert

The latest Correct Coding Initiative (CCI) release, version 15.2, brings welcome changes for your otolaryngology practices. Not only can you report nasal vestibule work and a septoplasty independent of each other, but you don't need to slap on a modifier when your ENT performs a laryngoscopy alongside a cervical lymphadenectomy.

"It is always good news when physicians are paid for all the procedures they perform," says Rhonda Hardison, CPC, clinical coding quality coordinator at the Lake Physician Group's Head and Neck Center in Baton Rouge, La.

No longer will you need to worry about an edit that bundles 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft) into 30465 (Repair of nasal vestibular stenosis [e.g., spreader grafting, lateral nasal wall reconstruction]).

"This is great news," says Janet Kidneigh, CPC, ENT pediatric surgery coder for UPI Inc. in Aurora, Colo. "My surgeons frequently do some nasal vestibule work with a septoplasty."

Prior to July 1, payers following Medicare rules would consider 30465 the more extensive procedure and pay only for this service, no matter what modifier you tried to append. That's 12.2 work relative value units (RVUs) or $440 (based on the 2009 conversion rate of $36.0666). Now, you can receive reimbursement for both procedures, although a 50 percent multiple surgery reduction applies for the septoplasty. That's 6.85 work RVUs or $250 times the 50 percent multiple surgery reduction or an increase of $125.

"This deleted bundle will increase the amount we are paid significantly," Kidneigh says.

Beware: Sometimes payers do not react swiftly to these types of changes. "As far as non-Medicare payers are concerned, I do not know how they will respond. We may have to educate them by means of appeals letters," Kidneigh laments.

Another pair of edits you can strike through focus on 31525 (Laryngoscopy, direct, with or without tracheoscopy; diagnostic, except newborn). Code 31525 is no longer a component of either 38720 (Cervical lymphadenectomy [complete]) or 38724 (Cervical lymphadenectomy [modified radical neck dissection]). In the past, you could have separated 31525 and 38720 with a modifier (such as 59, Distinct procedural service) -- so long as you had supporting documentation and circumstances. Similarly, you also could have separated 31525 and 38724 with a modifier.

Timesaver: Now that CMS deletes these edits, you don't need to worry about the modifier. You should expect reimbursement for both procedures.