Otolaryngology Coding Alert

Get updated with the latest 25 ME and 93 NME bundles.

Do you have to commonly report excision codes on the head 21011-21016? If so, pay attention to the latest Correct Coding Initiative (CCI) edits version 17.2, which went into effect on July 1, 2011. Twenty-five out of 322 mutually exclusive (ME) pairs concern otolaryngologists, while nonmutually exclusive (NME) edits include 93 out of 2,021 bundles from otolaryngology-related procedures such as repair, excision, endoscopy, and incision/destruction, to name a few.

Highlight These 25 ME Edits

In the latest CCI edits, only 25 mutually exclusive pairs should impact otolaryngologists. Mutually exclusive codes represent procedures or services that could not reasonably be performed, based on the code definitions or anatomic considerations, at the same session by the same provider on the same beneficiary.

The subcutaneous injection procedures on the integumentary system 11950-11954 are mutually exclusive with the comprehensive HCPCS code G0429 (Dermal filler injection[s] for the treatment of facial lipodystrophy syndrome [lds] [e.g., as a result of highly active antiretroviral therapy]). The code G0429 has the same function as 11950-11954, but the Centers for Medicare and Medicaid Services (CMS) created G0429 as a tracking code. You would use the G code only for CMS. For non-CMS, you would report 11950-11954.

The acellular dermal replacement codes 15175-15176 are mutually exclusive components of G0440 (Application of tissue cultured allogeneic skin substitute or dermal substitute; for use on lower limb, includes the site preparation and debridement if performed; first 25 sq cm or less) and G0441 (Application of tissue cultured allogeneic skin substitute or dermal substitute; for use on lower limb, includes the site preparation and debridement if performed; each additional 25 sq cm).

Logic: Again, CMS created these G codes just for them, so instead of using 15175-15176, you would use G0440-G0441. For non-Medicare, you would bill 15175-15176.

Also, allograft skin procedures 15320-15321, 15335-15341, 15365-15366 are mutually exclusive components of HCPCS codes for skin substitute G0440-G0441.

Endoscopy codes 31626 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of fiducial markers, single or multiple) and 31643 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of catheter[s] for intracavitary radioelement application) are bundled together as mutually exclusive pairs in the latest CCI edits.

Note: All of these bundles carry a modifier indicator of "1," which means you can report both procedures of a pair in certain, although unlikely circumstances. You may use a modifier like 59 (Distinct procedural service) to override the edit if the clinical circumstances merit separate reimbursement like a separate encounter on the same date, a separate anatomical site, separate encounter or a separate indication.

Catch The Repair Procedure NME Bundles

Furthermore, CCI edits 17.2 categorize 93 out of 2,021 as nonmutually exclusive pairs. For instance, simple repair procedures 12001-12007, 12020-12021; intermediate repair codes 12031-12037; and complex repair codes 13120-13121 classify as NME components of G0440.

Other NME component bundles include:

• 69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]) with G0440 and G0429
• 92531 (Spontaneous nystagmus, including gaze) and 92532 (Positional nystagmus test) with G0436 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes)
• 94681 (Oxygen uptake, expired gas analysis; including CO2 output, percentage oxygen extracted) with G0400 (Home sleep test [hst] with type iv portable monitor, unattended; minimum of 3 channels), G0399 (Home sleep test [hst] with type iii portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/ airflow, 1 ecg/heart rate and 1 oxygen saturation), and G0398 (Home sleep study test [hst] with type ii portable monitor, unattended; minimum of 7 channels: eeg, eog, emg, ecg/heart rate, airflow, respiratory effort and oxygen saturation)
• J2001 (Injection, lidocaine hcl for intravenous infusion, 10 mg) with G0429.

Don't forget: Nonmutually exclusive edits pair codes for two services that physicians often carry out during the same session. CCI lists one code as the comprehensive procedure (column 1), which means it is considered the larger procedure, and the second code (column 2) as the component, which is a piece of the comprehensive.

Meanwhile, excision procedures on the head 21011-21014 are comprehensive NMEs of codes:

• 10021 -- Fine needle aspiration; without imaging guidance
• 10022 -- ... with imaging guidance
• 12011 -- Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less
• 12013 -- ...2.6 cm to 5.0 cm
• 12014 -- ...5.1 cm to 7.5 cm
• 12015 -- ...7.6 cm to 12.5 cm
• 12016 -- ...12.6 cm to 20.0 cm
• 12017 -- ...20.1 cm to 30.0 cm
• 12018 -- ...over 30.0 cm.

Other otolaryngology-related NMEs on CCI edits 17.2 include:

• 21015 (Radical resection of tumor [e.g., malignant neoplasm], soft tissue of face or scalp; less than 2 cm) with 10021 and 10022
• 21016 (...2 cm or greater) with 10021 and 10022
• 21557 (Radical resection of tumor [e.g., malignant neoplasm], soft tissue of neck or anterior thorax; less than 5 cm) with 10021 and 10022
• 21558 (...5 cm or greater) with 10021 and 10022
• Endoscopy procedures on the accessory sinuses 31295-31297 with drug codes J0670 (Injection, mepivacaine hydrochloride, per 10 ml) and J2001 (Lidocaine IV infusion, 10mg)
• 69801 (Labyrinthotomy, with perfusion of vestibuloactive drug[s]; transcanal) with J0670 and J2001
• Allergy testing codes 95004-95065 with G0436 and G0437 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 10 minutes).

CCI assigns a modifier indicator of "0" to some of these NMEs, which means you cannot override the edit by reporting the appropriate modifier (e.g., modifier 59 is performed at a different anatomic site or different encounter on the same day). In short, you cannot report these procedures together under any circumstances. (For a tabular list of the latest ME and NME edits, you may email editor Claire Gamboa at cgamboa@codinginstitute.com.)