Otolaryngology Coding Alert

Pay attention to the modifier indicator to determine which ones you can override and which you can’t.

Every new year brings new, altered, and deleted codes that you must learn in order to keep your otolaryngologist’s reimbursement rolling in. And, on the heels of the code changes, the Correct Coding Initiative (CCI) adds to your learning curve by implementing a slew of new bundles.

CCI 19.0, which took effect on January 1, 2013, added 37,587 new bundles and deletes 16, 716. Not surprisingly, many of the new CCI edits target new 2013 CPT^® codes, and otolaryngology wasn’t spared any changes. Read on to find out which CCI changes might affect your coding.

Blend These Bronchoscopy Edits into Your Daily Coding Routine

If you frequently report 31635 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of foreign body), then you must take note of this new edit. Code 31635 is mutually exclusive to 31648 (… with removal of bronchial valve[s], initial lobe).

This edit has a modifier indicator of “1.” That means that you can use a modifier to override the bundling under specific clinical circumstances.

In addition, CCI considers 31647 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, when performed, assessment of air leak, airway sizing, and insertion of bronchial valve[s], initial lobe), 31648 (… with removal of bronchial valve(s), initial lobe), and 31651 (… with balloon occlusion, when performed, assessment of air leak, airway sizing, and insertion of bronchial valve[s], each additional lobe [List separately in addition to code for primary procedure(s)]) mutually exclusive to 31615 (Tracheobronchoscopy through established tracheostomy incision). Again, these edits have a modifier indicator of “1,” which means you can use a modifier to override the bundling under specific clinical circumstances.

CCI Targets New Allergy Codes 95017, 95018

CCI 19.0 makes 95028 (Intracutaneous [intradermal] tests with allergenic extracts, delayed type reaction, including reading, specify number of tests) mutually exclusive to new codes:

·         95017 (Allergy testing, any combination of percutaneous [scratch, puncture, prick] and intracutaneous [intradermal], sequential and incremental, with venoms, immediate type reaction, including test interpretation and report, specify number of tests) and

·         95018 (Allergy testing, any combination of percutaneous (scratch, puncture, prick) and intracutaneous [intradermal], sequential and incremental, with drugs or biologicals, immediate type reaction, including test interpretation and report, specify number of tests).

These edits allow you to use a modifier, but make sure you have documentation and modifiers to support that. For instance, you would use this modifier if your physician tests different allergies/antigens with 95028 as compared to testing the allergies/antigens with either 95017 or 95018.  In addition to different allergies, the physician would use different testing sites. The documentation must make the medical necessity for the delayed test evident. 

Check Out Non-Mutually Exclusive Bundles

Non-mutually exclusive edits represent procedures CMS has determined physicians should not bill together because one service inherently includes the other. These are also known as bundled services or comprehensive/component edits.

Code 38724 (Cervical lymphadenectomy [modified radical neck dissection]) is subject to a non-mutually exclusive bundle. Code 38724 now includes the work involved with electromyography procedures (95860-95866 and 95868-95870), nerve conduction tests (95907-95913), evoked potential and reflex testing procedures (95925-95937), intraoperative neurophysiology procedure code 95940, and continuous neurophysiology monitoring code G0453. All of these bundles prevent you separating them with a modifier.

Similarly, parathyroidectomy codes 60500-60505 now include the work involved with parathyroid planar imaging codes (78071-78072), electromyography procedures (95863-95866 and 95869-95870), nerve conduction tests (95907-95913), evoked potential and reflex testing procedures (95928-95929), intraoperative neurophysiology procedure code 95940, and continuous neurophysiology monitoring code G0453. All of these bundles have a modifier indicator of “0,” which means you cannot use a modifier to override the CCI bundles.

Apply These New Chemodenervation Edits

Reporting chemodenervation services? Then you’ll want to take note of the following new non-mutually exclusive edits.

Chemodenervation codes 64612 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve, unilateral [e.g., for blepharospasm, hemifacial spasm]) (Botox injections for headaches) and 64613 (…neck muscle[s] [e.g., for spasmodic torticollis, spasmodic dysphonia]) (percutaneous laryngeal Botox injections) now include the work represented by electromyography procedure codes 95865-95866, nerve conduction tests (95907-95913), intraoperative neurophysiology procedure code 95940, and continuous neurophysiology monitoring code G0453. All of these bundles have a modifier indicator of “0,” which means you may not use a modifier to override these bundles.

CCI Aims New Bundles at Allergy Services

Allergy testing procedures 95004-95071 don’t escape CCI 19.0’s notice and receive a slew of non-mutually exclusive edits, including:

·         New patient preventive medicine services 99381-99387

·         Established patient preventive medicine services 99391-99397

·         Counseling risk factor reduction and behavior change intervention codes 99401-99412

·         Interpretation of health risk assessment code 99420, and

·         Supervision of interfacility transport care code 99485.

The new allergy testing codes (95017-95018) receive extra E/M bundles, which include office or other outpatient visit codes 99201-99215, hospital observation service codes 99217-99226, subsequent hospital care service codes 99231-99239, new or established patient emergency department service codes 99281-99285, critical care services code 99291, nursing facility service codes 99304-99318, etc.