Otolaryngology Coding Alert

This checklist will get you charging supplies without unbundling.

Before you accept another biller's advice to increase revenue by reporting 99070, make sure you verify these details.

You can only bill supplies, such as with 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drug, supplies, or materials provided]), for which you incur a cost in the office (POS 11). For instance, if your ENT treats a nasal bone fracture with stabilization (21320, Closed treatment of nasal bone fracture; with stabilization) at an ambulatory surgical center (POS 24),the facility would bill the stabilization items (splints, gauze, etc.) because it would supply them, explains Karla M. Westerfield, business manager at Southeast Wyoming Ear, Nose & Throat Clinic PC, in Cheyenne.

The AMA and Medicare already factor essentials into a code's values on the physician fee schedule. A procedure's office practice expense value units are usually more than its facility practice expense to cover the materials, explains Michelle Logsdon, CPC, CCS-P, at Falcon Practice Management in Toms River, N.J.

"If you-re doing a procedure in the office that requires tools, surgical trays, or other supplies, the reasonable expectation is that you will be using equipment and that those costs have been accounted for in the price's procedure," Westerfield notes.

For example, if the doctor does a biopsy in the office (such as 11100, Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion), he will use equipment to do it, and he may need to bandage the biopsy site. "We build a factor into our base cost for equipment replacement/purchasing, autoclaving, bandaging, etc."

Exception: Private payers that do not follow the fee schedule might not include supply costs in their payments. In these cases, you could be paid for the item(s).

When you-re charging an E/M in place of a procedure code, however, the supply cost wouldn't be built in. For instance, if you opt to itemize nasal fracture care with office visit codes (99201-99215), you could charge the splint.

Or, if an ENT provides the initial care only, and refers the patient out for global and postoperative care, you could report the office visit and splint.

"If cast application or strapping is provided as an initial service (e.g., casting of a sprained ankle or knee) in which no other procedure or treatment (e.g., surgical repair, reduction of a fracture or joint dislocation) is performed or is expected to be performed by a physician rendering the initial care only, use the casting, strapping and/or supply code (99070) in addition to an evaluation and management code as appropriate," according to CPT.

But if you code the global fracture care, you would include the supply.

"I have once come across this scenario and did not code 99070 along with 21320," recalls Amit Joshi, MSc, senior medical coder for Prexis Health India Ltd. in Pace City II, Gurgaon, India.

When an encounter requires more supplies than usual, you might code them. "It is rarely appropriate to include extra supplies: If the procedure becomes more complex (possibly requiring more supplies), then you would probably upcode the procedure, not just add extra supplies," Westerfield cautions.

The one occasion Westerfield's practice does use 99070 is when a patient is self-administering allergy injections and has cut back the amount of extract per injection.

"For instance," she says, "if we give the patient 10 needles for 10 doses and they actually break the 10-dose extract into 20 doses, we will charge 99070 for extra syringes, along with exploring the patient's reasons for reducing the amount of extract per injection."

You-re better off using a HCPCS level-II supply code, rather than CPT's miscellaneous supply code. If no specific code exists, you can use the generic code. Include the item's name on line 19 of the CMS-1500 form. Be prepared to submit a copy of the invoice.

Not all insurers, however, accept the generic code even with documentation. "We have not found insurances that will pay this, and we do collect from the patient at the time of service," Westerfield says.

Coders on the East Coast have discovered the same drawback. "I do not have any luck [receiving payments] for any office that wants to bill 99070," agrees Logsdon.

CMS lists 99070 as a "B" bundled code with 0 relative value units on the 2008 Medicare Physician Fee Schedule. The status means, "Payment for covered services are always bundled into payment for other services not specified ... If these services are covered, payment for them is subsumed by the payment for the services to which they are incident. (An example is a telephone call from a hospital nurse regarding care of a patient).