Otolaryngology Coding Alert

But – The changes won’t alter your coding much.

The latest version of Correct Coding Initiative (CCI) edits went into effect on April 1, and includes thousands of new edit pairs that pertain to otolaryngology. In other words, virtually any procedure your physician performs is listed in the bundles.

Tip: There are so many edits in place, it will be easier for you to learn and implement the exceptions rather than the applicable edits themselves.

Pay Attention to IV Infusion Procedures

Every otolaryngology code included in CCI 22.1 edits is considered a Column 1 code with each of these IV infusion procedures:

• +96361 – Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure)
• +96366 – Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)
• +96367 – Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion of a new drug/substance, up to 1 hour (List separately in addition to code for primary procedure)
• +96368 – Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for primary procedure).

As the Column 1 code, you should only report the otolaryngology procedure (such as 60252, Thyroidectomy, total or subtotal for malignancy; with limited neck dissection) if performed during the same encounter as one of, the four IV infusion codes above.

Good news: Each edit pair carries a modifier indicator of “1,” meaning that you might be able to report both codes in an edit pair if you have sufficient documentation to support separate coding. If so, you should append a modifier (such as 59, Distinct procedural service) to the Column 2 code.

“Otolaryngologists are rarely involved in infusions, so these edits won’t affect them very much,” says Barbara J. Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO, vice president at Stark Coding & Consulting, LLC, in Shrewsbury, N.J. “But it’s still good to know about edits in the specialty even if you don’t expect to use them.”

Watch for Edit Exceptions

Although CCI 22.1 bundles the add-on IV infusion codes into virtually every ENT-related procedure in CPT^®, you’ll still be able to report some services without the work of trying to override an edit. The following procedures can be submitted on the same claim as the IV infusion codes without any special documentation (other than clear notes regarding the services provided):

“Unlisted” codes such as:

    o 31299 – Unlisted procedure, accessory sinuses
    o 31599 – Unlisted procedure, larynx
    o 31899 – Unlisted procedure, trachea, bronchi
    o 40899 – Unlisted procedure, vestibule of mouth
    o 42699 – Unlisted procedure, salivary glands or ducts
    o 42999 – Unlisted procedure, pharynx, adenoids, or tonsils

Bronchoscopy add-on codes:

    o +31627 – Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with computer-assisted, image-guided navigation (List separately in addition to code for primary procedure[s])
    o +31632 – … with transbronchial lung biopsy(s), each additional lobe (List separately in addition to code for primary procedure)
    o +31633 – … with transbronchial needle aspiration biopsy(s), each additional lobe (List separately in addition to code for primary procedure)

Canalith repositioning (95992, Canalith repositioning procedure[s] [e.g., Epley maneuver, Semont maneuver], per day).

The edits also do not apply to allergy testing procedures (95004-95071) or allergen immunotherapy services (95115-95119).