Otolaryngology Coding Alert

This year is all about code description revisions for ENT coders.

From a coder’s perspective, this is undoubtedly the most exciting time of the year. While the annual installment ICD-10-CM codes tends to generate plenty of buzz, the release of CPT^® changes for the 2020 calendar year (CY) is what most of the coding community has been anticipating among all else.

You’ll typically evaluate the CPT^® changes from the perspective of your given specialty. From the viewpoint of an otolaryngology coder, this year offers you plenty to consider. While the new surgical codes are kept to a minimum, there’s a host of revisions to the nasal endoscopic surgery code section that you’ll want to get familiar with. Furthermore, you’ll want to make note of a few important additions and revisions to the evaluation and management (E/M) code set — specifically for online digital E/M services.

Dive in and have a look at this definitive guide for otolaryngology-specific CPT^® coding changes for the 2020 CY.

See New and Revised Changes to E/M Code Set

Practically speaking, you might be relieved to find that the 2020 changes to the E/M code set are unlikely to have a profound impact on your day-to-day coding responsibilities. The most substantial changes come by the way of some new codes for online digital E/M services for established patients. Have a look at the following codes:

• 99421 (Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes)
• 99422 (… 11-20 minutes)
• 99423 (… 21 or more minutes).

These codes will be replacing the wordy 99444 (Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network), which will be deleted for 2020.

Consider Meaning to FESS Code Description Revisions

The primary focus of the 2020 CPT^® updates involves an assortment of code description revisions for functional endoscopic sinus surgery (FESS) codes. Have a look at each respective revision (note that the strikethrough outlines the prior description and the underline outlines the revised description):

• 31233 (Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture); with maxillary sinusoscopy (via inferior meatus or canine fossa puncture))
• 31235 (with sphenoid sinusoscopy (via puncture of sphenoidal face or cannulation of ostium))
• 31292 (Nasal/sinus endoscopy, surgical, with orbital decompression; with medial or inferior orbital wall decompression)
• 31293 (with medial orbital wall and inferior orbital wall decompression)
• 31294 (Nasal/sinus endoscopy, surgical, with optic nerve decompression; with optic nerve decompression)
• 31295 (Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); with dilation of maxillary sinus ostium (eg, balloon dilation), transnasal or via canine fossa)
• 31296 (with dilation of frontal sinus ostium (eg, balloon dilation))
• 31297 (with dilation of sphenoid sinus ostium (eg, balloon dilation))
• 31298 (with dilation of frontal and sphenoid sinus ostia (eg, balloon dilation)).

It’s important to understand the significance of these revisions. On the surface, they may seem like inconsequential semantic changes. But if you look further, you’ll see that with the mere movement of a semicolon, the code’s fundamental DNA changes. For instance, have a look at codes 31233 and 31235. Prior to 2020, you’ll notice that each respective code stands on its own (also known as a standalone code). The 2019 and prior version of 31233 exists as “Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)” and 31235 as “Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoidal face or cannulation of ostium).” As you can see, no semicolon exists within either code description, meaning that both can be viewed as their own separate entities.

With the updated 2020 CPT^® changes, you can see that 31233 now includes a semicolon following “Nasal/sinus endoscopy, diagnostic.” This now opens the door to the possibility of one or more indented codes that use the code description included before the semicolon within their code descriptions. That’s where the 31235 comes in to play; 31235, previously existing as a stand-alone code, is now an indented code 31233. You may be wondering what impact, if any, this will have on you, as a coder. The impact won’t change the way coders submit these procedures, nor will it change the way payers reimburse for them (outside of any possible fee schedule changes).

The underlying reason for the changes are presumably for no other reason than that it’s practical. As new codes continue to be added to the CPT^® manual, the American Medical Association (AMA) looks for ways to abbreviate and shorten existing code descriptions where it’s feasible. That’s especially apparent with the revisions to codes 31296-31298. These three codes, which are indented codes to the base code 31295, are now simplified to anatomic site, alone. By placing the description “with dilation (eg, balloon dilation)” prior to the semicolon, indented codes 31296-31298 do not need to include any additional, redundant language.

Coder’s note: “Coders must understand the importance of reviewing the revised CPT^® codes the AMA publishes each year — since the result of using a code description that has been revised could be that the claim does not get paid,” says Ronda Tews, CPC, CHC, CCS-P, AAPC Fellow, director of billing and coding compliance at Modernizing Medicine in Boca Raton, Florida. “However, without a review of the code description changes for your specialty each year, the implications could be significantly worse — the claim could get paid when it shouldn’t,” warns Tews.

Note 2 Additions to Medicine Section

The last coding consideration you’ll want to make comes within the Medicine chapter of the CPT^® manual. The CPT^® manual revises the following two auditory function evaluation codes:

• 92626 (Evaluation of auditory rehabilitation function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); first hour)
• +92627 (… each additional 15 minutes (List separately in addition to code for primary procedure)).