Otolaryngology Coding Alert

This revised definition will help you avoid this common turbinate coblation pitfall.

Descriptors with tumor size quantifiers are among the big changes to otolaryngology codes for CPT 2010, and if you're going to correctly bill these procedures, then you need to alert your physicians to specify these excision or radical resection dimensions in their documentation.

Here's the good news: Expanding your excision, radial resection, and ablation options means that you're less likely to make coding mistakes. Examine these new otolaryngology CPT entries and start using them Jan. 1.

Cut to the New Excision Code Chase When your otolaryngologist treats a patient with a really deep facial tumor, you've been stuck using 11440-11446 (Excision, other benign lesion including  margins, except skin tag [unless listed elsewhere], face, ears, eyelids, nose, lips, mucous membrane ...), which are for "more for superficial lesions," explains Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CENTC, CHCC, president of N.J.-based CRN Healthcare Solutions.

As of Jan. 1, you will have four new tumor excision codes to add to your arsenal. They are:

• 21011 -- Excision, tumor, soft tissue of face or scalp, subcutaneous; less than 2 cm

• 21012 -- ... 2 cm or greater

• 21013 -- Excision, tumor, soft tissue of face and scalp, subfascial (e.g., subgaleal, intramuscular); less than 2 cm

• 21014 -- ... 2 cm or greater.

Difference: The new codes are "for much deeper, more complex lesions," Cobuzzi says -- hence referencing tumors. Also, up until 2010, "we have had deeper tumor excision codes for the neck, but they have not been available for the face and scalp. This will no longer be the case."

The excision changes don't stop there. Also new for these procedures are the following size-specific additions:

• 21552 -- Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; 3 cm or greater

• 21554 -- Excision, tumor, soft tissue of neck or anterior thorax, subfascial [e.g., intramuscular]; 5 cm or greater.

Also, CPT revised these existing codes to say (emphasis added) 21555 (Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; less than 3 cm) and 21556 (Excision, tumor, soft tissue of neck or anterior thorax, subfascial [e.g., intramuscular]; less than 5 cm).

Heads up: "These codes are now explaining the neck.

Notice how the descriptors don't say 'malignant,' which means you're not compelled to have a malignant neoplasm when your note specifies 'tumor,'" Cobuzzi says. "Until these codes, there has never been a way to express the depth of removing a tumor or tumorous mass of the face or scalp except with modifier 22 (Unusual procedural services) added to 1144x," says Leslie Johnson, CPC, quality control auditor for Duke University Health System and owner of the billing and coding Web site AskLeslie.net.

"In theory, the size of a tumor should fairly well reflect the depth and difficulty in terms of work that has to be done to remove the tumors," Johnson says. "Payment received should be reflective of that work -- more money for more work."

Ramp Up to These Radical Resection Changes CPT altered the above excision codes to specify size -- and the same goes for radical resection of soft tissue codes. For instance, the descriptor for 21015 now states (emphasis added) "Radical resection of tumor (e.g., malignant neoplasm), soft tissue of face or scalp; less than 2 cm." You can also add new code 21016 (... 2 cm or greater) to your radical resection arsenal.

Example: Your otolaryngologist performs a radical resection of a tumor present on the patient's face. He documents, "The tumor measures approximately 3 cm insize." In this instance, you would report new code 21016.

Bonus: The trend for size delineation doesn't stop there. Sometimes scar excisions are so severe that a physician must use an adjacent tissue transfer to close the wound. Although your otolaryngologist may not deal with 30 sq cm or greater sizes very often, you should note that CPT deleted 14300 and added new codes 14301 (Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm) and add-on code +14302 (Adjacent tissue transfer or rearrangement, any area; each additional 30.0 sq cm, or part thereof [List separately in addition to code for primary procedure]). "It's interesting they added this delineation," Cobuzzi says.

Avoid Ablation Mistakes With RF Inclusion If your otolaryngologist ablates mucosa using radiofrequency (RF), then your coding just got clearer.

CPT revised ablation codes to state:

• 30801 -- Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (e.g., electrocautery, radiofrequency ablation, or tissue volume reduction); superficial

• 30802 -- Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (e.g., electrocautery, radiofrequency ablation, or tissue volume reduction); intramural (i.e., submucosal).

Choose 30801 or 30802 based on the mucosa the otolaryngologist ablates using RF. CPT code 30802 is intramural ablation or cauterization of the deeper mucosa, whereas 30801 is superficial ablation or cauterization, which involves only the outer layer of the mucosa, experts say.

Pitfall: Some physicians were incorrectly reporting 30140-52 (Submucous resection inferior turbinate, partial or complete, any method; Reduced services) when an otolaryngologist performs turbinate "coblation," but coblation doesn't involve incision or excision. During coblation, the otolaryngologist uses radiofrequency (RF) energy to remove or shrink soft-tissue turbinate volume. You should report the electrical current destruction process as ablation (30801 or 30802). Because coblation or RF ablation destroys the mucosa from within, you should report 30802.

"The 'radiofrequency ablation' part of the code descriptors leave no question what codes you should report," Cobuzzi cheers.