Otolaryngology Coding Alert

Remember: If a Category III code exists, then you should forgo an unlisted code.

You may just be digging in to your 2012 CPT^® book, but the Correct Coding Initiative (CCI) has already taken aim at some of the new codes by bundling them into existing codes effective Jan. 1.

Background: The CCI released version 18.0 at the end of 2012, revealing 15,530 new active pairs and 6,197 code pair deletions, said Frank D. Cohen, MPA, MBB, senior analyst with The Frank Cohen Group, LLC, in his analysis of the changes.

Take a moment to learn how CCI affects your wound, bronchoscopy, and parathyroidectomy services. Here's the good news: Although you'll see a varied array of allowed modifier use, most of these edits reflect either CPT guidelines or common sense.

1. Count New EMG Code As Part Of 60500-60505

CCI 18.0 didn't overlook new code 95938 (Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper and lower limbs).

This code is now part of parathyroidectomy codes 60500-60505 (Parathyroidectomy or exploration of parathyroid[s]; ...). All of these edits allow you to add a modifier to 95938 should your otolarlyngologist's documentation warrants separate procedure coding.

2. Don't Let These Skin Edits Get Under Your Skin

You have several skin and tissue edits you should apply -- sooner rather than later.

First of all, skin debridement codes 11004-11006 now officially include the work represented by 15777 (Implantation of biologic implant [e.g., acellular dermal matrix] for soft tissue reinforcement [e.g., breast, trunk] [List separately in addition to code for primary procedure]), but "this is merely a reflection of CPT and CMS manual instructions. Therefore, this shouldn't be a surprise," says Barbara Cobuzzi, MBA, CPC, CENTC, CPCH, CPCP, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J.

Adjacent tissue transfer codes 14020-14021, 14040, and 14060-14061 all include 20527 (Injection, enzyme [e.g., collagenase], palmar fascial cord [i.e., Dupuytren's contracture]).

Autograft codes 15040, 15116, 15121, 15136, and 15156-15157 all include 97602 (Removal of devitalized tissue from wound[s], non-selective debridement, without anesthesia [e.g., wet-to-moist dressings, enzymatic, abrasion], including topical application[s], wound assessment, and instruction(s) for ongoing care, per session). However, this follows CPT Manual and CMS coding manual instructions, so this shouldn't stun you.

For all of the skin related edits mentioned above, you can separate these edits with a modifier (such as, 59, Distinct procedural service), but the otolaryngologist must provide documentation to back this up. This would include "a separate site or separate session," Cobuzzi says.

Finally, you have a bunch of skin substitute graft edits to learn. Remember, you have new 2012 autograft codes based on the wound site and size. For instance, for wounds to areas such as the face and mouth, you should be looking to new codes 15275-15278 (Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits ...).

Because these codes are new, CCI 18.0 adds numerous new edits attached to the code. These bundles have various modifier indicators, so make sure you check before you try to separate them.

3. Catch These Category III Bronchoscopy Edits

If your otolaryngologist performs the service described by 0276T (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe), then you are obligated to report this using the Category III code -- and not an unlisted one.

However, you should be cautious about reporting this code with other CPT codes, as CCI 18.0 brings a slew of edits that make 0276T a comprehensive code. You'll find codes bundled into 0276T for a variety of reasons, including 0276T being a more extensive procedure and codes that fall under CPT's "separate procedure" definition.

Here are what codes to avoid when reporting 0276T:

Similarly, you should avoid reporting the following procedures with 0277T (... with bronchial thermoplasty, 2 or more lobes):

In the majority of these cases, the modifier indicator is "1," so if your otolaryngologist provides clear documentation to warrant modifier, you can report these services separately.

* These edits have a modifier indicator of "0," meaning you cannot separate them with a modifier.