Otolaryngology Coding Alert

Plus: Don’t miss the new codes for chronic care management services. 

The American Medical Association (AMA) has released its initial list of CPT® code updates for 2015, and several apply specifically otolaryngology practices. Read on for details on how your esophagoscopy coding will change starting Jan. 1, and get the lowdown on other additions, revisions, and deletions for your practice. 

Look How Esophagoscopy Codes Will Include More Services

Your biggest procedure coding changes will be related to esophagoscopy. CPT® 2015 will include one new code, as well as revisions to six others. 

New option: The new code will be 43180 (Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus (eg, Zenker’s diverticulum), with cricopharyngeal myotomy, includes use of telescope or operating microscope and repair, when performed). 

“The good news is that otolaryngologists finally have gotten a code for doing endoscopic repair of Zenker’s diverticulum,” says Barbara J. Cobuzzi, MBA, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J. “Coders will no longer have to use an unlisted code to report this service and for now on will use 43180 to report the endoscopic repair of Zenker’s diverticulum.”

Most revisions to the familiar codes are minor, but still important. The revised codes (and their changes) are as follows:

• 43194 – Esophagoscopy, rigid, transoral; with removal of foreign body(s). The designation of “foreign body” was changed to be either singular or plural. 
• 43197 – Esophagoscopy, flexible, transnasal; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure). The word “includes” in the previous code descriptor will change to “including.”
• 43215 – Esophagoscopy, flexible, transoral; with removal of foreign body(s). The designation of “foreign body” was changed to be either singular or plural. 
• 43216 – Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps. The previous descriptor applied to removal by hot biopsy forceps or bipolar cautery. The bipolar cautery designation will be deleted for 2015.
• 43247 – Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s). The designation of “foreign body” was changed to be either singular or plural.
• 43250 –  Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps. As with 43216, the inclusion of bipolar cautery in this code will be deleted for 2015.

Important: Codes 43215, 43216, 43247, and 43250 include a “bulls-eye” designation. That means the valuation of the code already includes moderate sedation. Therefore, you wouldn’t report a moderate sedation code such as 99143 (Moderate sedation services [other than those services described by codes 00100-01999] provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; younger than 5 years of age, first 30 minutes intra-service time) with any of these procedures. 

Eliminate 3 Eustachian Tube Procedure Options 

Three codes for procedures related to Eustachian tube inflation and/or catheterization will no longer be valid, beginning Jan. 1, 2015. They are: 

• 69400 – Eustachian tube inflation, transnasal; with catheterization 
• 69401 – … without catheterization
• 69405 – Eustachian tube catheterization; transtympanic.

Check When Chronic Care Management Might Apply 

CPT® 2013 introduced three new codes for complex chronic care coordination services (99487, 99498, and +99489). CPT® 2015 expands on this concept by adding two codes for chronic care management services: 

• 99490 – Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements:
  

                  o multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient,
                  o chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline,
                  o comprehensive care plan established, implemented, revised, or monitored. 

• +99498 – … each additional 30 minutes (List separately in addition to code for primary procedure). 

Specialists such as pain management, oncology, or family practice physicians probably will use these codes most often. An otolaryngologist might have need for them in special circumstances, however, which is why it’s good to be aware of the options. 

Watch for more details about all the 2015 code changes in Otolaryngology Coding Alert as more details become available.