Otolaryngology Coding Alert

Hint: The test overrides several non-face-to-face services. 

New Correct Coding Initiative (CCI) edits became effective April 1, which means it’s time for you to brush up on paired procedures you can’t report together – again. 

The lowdown: CCI 20.1 had fewer edits than earlier releases in 2014, which is expected as the year goes along. All edits pertaining to otolaryngologists fall under the classification of “non-mutually exclusive edits,” or Column 1/Column 2 edits. The code listed in Column 1 includes the service represented by the code in Column 2, so there’s no need to report both codes. 

Watch for Allergy Test Bundles 

Edits that could apply to otolaryngologists all pertain to different allergy testing. In each situation, the allergy test is listed as the Column 1 code of the pair, which means that’s the code you should report. The six allergy test procedures involved are: 

• 95004 – Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests 
• 95024 – Intracutaneous (intradermal) tests with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests
• 95027 – Intracutaneous (intradermal) tests, sequential and incremental, with allergenic extracts for airborne allergens, immediate type reaction, including test interpretation and report, specify number of tests 
• 95028 – Intracutaneous (intradermal) tests with allergenic extracts, delayed type reaction, including reading, specify number of tests
• 95044 – Patch or application test(s) (specify number of tests)
• 95052 – Photo patch test(s) (specify number of tests).

Each of these codes is newly bundled with several face-to-face services including office consultations for new or established patients (99241-99245), inpatient consultations for new or established patients (99251-99255), and the first hour of prolonged E/M before and/or after direct patient care (99358). 

CCI 20.1 also clarifies that the allergy test codes should be reported instead of the following non-face-to-face services:

• 99441-99443 for telephone evaluations 
• 99444 for online evaluations 
• 99446-99449 for interprofessional telephone evaluations 
• 99487 and 99488 for complex chronic care coordination services 
• 99495 and 99496 for transitional care management services. 

Good news: All edits in CCI 20.1 related to these code pairs carry a modifier indicator of “1.” That means you can append a modifier when appropriate and possibly be allowed to report both procedure codes. Before filing the claim, ensure you have adequate documentation of both services and notes from the physician stating why both codes should be allowed. 

“The modifiers are used to unbundle these pairs in one of two situations,” says Barbara J. Cobuzzi, MBA, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J. “The first situation is when the E/M service is performed for the decision to perform the testing as a result of the E/M service.”  

Example 1: A patient is sent to the otolaryngology practice by his PCP for the otolaryngologist’s opinion on the patient’s recurrent nasal problem (post nasal drip, nasal obstruction, and Eustachian tube dysfunction). As a result of the work up that the otolaryngologist performed, she recommends that the patient have allergy testing performed. The patient has time to get the testing done that day and there is space in the allergy schedule, so they agree to conduct the testing immediately on this day. Since the patient was not sent to the otolaryngologist’s office for allergy testing, and it was only decided to perform the testing after working up the patient, this day’s services can be coded as 9924x-25 and the allergy testing codes.

Example 2: The second scenario that would occur includes when an unrelated E/M service with the testing is performed, as was discussed above with the patient who complained of ear pain on the same day of the allergy testing. “In this case, a 25 modifier for significant and separately identifiable E/M service is used,” Cobuzzi says.