Otolaryngology Coding Alert

New codes will improve how you report prolonged services.

You already know that 2016 will bring new and revised CPT^® codes for otolaryngology practices such as 92537 Caloric vestibular test with recording, bilateral; bithermal [i.e., one warm and one cool irrigation in each ear for a total of four irrigations]) and 0406T (Nasal endoscopy, surgical, ethmoid sinus, placement of drug eluting implant). But don’t miss two additions to the E/M section that could come in handy for your physician.

CPT^® 2016 will introduce two add-on E/M codes to help you capture work your clinical staff performs after your physician sees the patient for an E/M service. They are:

• 99415 – Prolonged clinical staff service (the service beyond the typical service time) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour (List separately in addition to code for outpatient Evaluation and Management service)
• 99416 – …each additional 30 minutes (List separately in addition to code for prolonged services).

“Now here is a set of codes to really sink your teeth into; we hope!” says Suzan (Berman) Hauptman, MPM, CPC, CEMC, CEDC, director of PB Central Coding at Allegheny Health Network in Pittsburgh, Pa. “Often times, a physician’s time with the patient only paints a partial picture of what occurred during the visit. It could have been that the staff was asked to give an injection, but the patient was uncooperative. It might include education for a new medication, therapy, or options for care that go far beyond the time illustrated in the E/M code, but, that education doesn’t have to be that of the physician.

“The staff [members] in a physician’s office are important to the care of the patient and also are an expense to the physician,” she continues. “These codes make good sense all around to be included in the new code sets. This may also come into play with the trend of coverage for more preventive services. I am anxious to see how these codes play out in policy and, if reimbursable, what might that reimbursement look like.”

“Remember that although these codes have been added, we cannot be assured that they will be paid,” notes Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CENTC, CPCO, vice president of the coding and consulting division of J. & S. Stark Billing & Consulting, Inc., in Shrewsbury, N.J. “If they are given a status of ‘B’ for bundled, they will have no add-on fee assigned to them by CMS. Similarly, private payers may or may not cover these add-on codes.”