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Otolaryngology Coding Alert

CPT 2005:

These 3 New Codes Help You Avoid Unlisted-Procedure Filing Hassles

Published on Wed Nov 03, 2004

You can replace 31599 and 92700 with 31545-31546

Two new codes for laryngoscopy procedures and one code for tinnitus evaluations will reduce your workload in 2005. 

Otolaryngology coders have to spend extra time handling claims containing unlisted-procedure codes. CPT 2005, however, eases your reimbursement problems with three new codes that describe previously undefined procedures.

Codes 31545-31546 Eliminate 31599's Billing Burden

You can say goodbye to filing 31599 for two procedures. Prior to CPT 2005, "no code combined laryngeal tumor removal with reconstruction," says Asia Evans, coding specialist at Head and Neck Surgery Associates, which has seven otolaryngologists, in Indianapolis. "Having specific codes that describe all these components will be great for otolaryngologists."

Old way: In 2004, coders should have reported the complex laryngoscopy procedure with unlisted-procedure code 31599 (Unlisted procedure, larynx), says Charles F. Koopmann Jr., MD, MHSA, professor and associate chair at the University of Michigan's department of otolaryngology in Ann Arbor. "CPT contained no code for visually enhanced [telescopic] mucosal removal of a benign neoplasm with a mucosal flap or a flap and autograft."

Problem: When you had to use 31599 to describe a laryngoscopy with biopsy and flap reconstruction, "reimbursement was uncertain," says Richard W. Waguespack, MD, FACS, the American Academy of Otolaryngology Head and Neck Surgery's (AAO-HNS) adviser to the AMA CPT Panel. Because an unlisted-procedure code contains no relative value units, insurers can decide how much to pay for the operation. Therefore, otolaryngologists had no way of ensuring that they would receive appropriate procedural payment.

You also had to spend more time filing the claim. When you submit a claim containing an unlisted-procedure code, you have to send in supporting documentation, including a letter explaining the surgeon's work and the operative notes.

Many payers separate the documentation from the claim on initial submission. So, you either have to wait for the insurer to request the additional information or resend the documentation. In either case, the procedure delays payment. Luckily, CPT makes these reimbursement hassles a thing of the past for two laryngoscopy procedures.

New way: Starting Jan. 1, you'll have two specific codes to report laryngoscopies that involve lesion removal and flaps. "You should use these new codes when the otolaryngologist performs a submucosal removal of a benign neoplasm and reapproximates the mucosal flap or places a graft," Koopmann says. The codes will read:

  • 31545 - Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with local tissue flap(s)
  • 31546 - Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal    removal of non-neoplastic lesion(s) of vocal cord; reconstruction with graft(s) (includes obtaining autograft).

    Technical Advances Call for New Larynx Codes

    To avoid using an unlisted-procedure code, some coders may have reported the procedure with 31536 (Laryngoscopy, direct, operative ...). "But this code doesn't reflect the technical evolution and additional expertise that voice-improvement surgery now uses," Waguespack says.

    Code 31536 describes an obsolete concept. "But it was the closest code" until CPT 2005 introduced 31545-31546, Waguespack says. The old code, which is still valid, suggests gross removal of tumor masses, including grabbing and ripping of tissue, as well as vocal cord stripping. "Otolaryngologists no longer use this brand of operation," he says.

    New method: Otolaryngologists now treat the mucosa differently. After removing the benign neoplasm, the otolaryngologist resects the submucosa and also places an autograft. The new codes' values reflect the increased work these cases involve, Koopmann says.

    Code 92625 Paves the Way to Payment

    You'll also receive work credit for tinnitus evaluations, thanks to CPT 2005's introduction of a tinnitus assessment code. "The new code will provide otolaryngology practices with a reimbursement mechanism for these procedures," says Debbie Abel, AuD, chair of the American Academy of Audiology's (AAA) Coding and Practice Management Committee.

    Old way: Prior to 2005, CPT contained no specific code for tinnitus assessment. "You had to use 92700 (Unlisted otorhinolaryngological service or procedure), Abel says.

    Problem: Because Medicare assigns no national relative value or description to an unlisted-procedure code, submitting 92700 caused payment problems and filing hassles. "Practices received poor reimbursement at best," Abel says. And using 92700 meant more work for office staff.

    New way: When your otolaryngologist or audiologist performs a tinnitus assessment, you should assign 92625, Assessment of tinnitus (includes pitch, loudness matching, and masking).

    Tinnitus Code Involves Assessing Ringing

    You'll be better able to use 92625 correctly if you know what the tinnitus assessment includes. In a tinnitus assessment, an otolaryngologist performs tinnitus matching, Abel says. Coders should look for a note in which the physician finds the sound's intensity and tries to locate "where" the patient's tinnitus resides in frequency terms.

    The assessment benefits patients in two ways. It helps the otolaryngologist understand a sound's impact on a patient, Abel says. The assessment may also determine if the patient exhibits residual inhibition, which means he doesn't hear the tinnitus when the physician plays another sound.

    Tip: Report 92625 when an otolaryngologist considers treatment options, such as tinnitus retraining therapy.

    CMS Eliminates Grace Period

    For Medicare and Medicaid carriers, make sure you start submitting the new codes for laryngoscopy and tinnitus on Jan. 1.

    CMS discontinued the 90-day grace period practices previously had to implement the new code set. You must report the HCPCS code that is valid at the time of service.

    Private payers may adopt this guideline, which CMS based on HIPAA. Look for a notice from insurers.

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