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Otolaryngology Coding Alert

Do You Know the 3 Code Sets You Shouldn't Report This Fall?

Published on Fri Oct 01, 2004

NCCI bundles needle placement into thyroid-cyst aspiration

If you regularly report a consult with an admit, fluoroscopic guidance with cyst injection, or an audiogram with cochlear-implant tuning, you could be committing fraud.

Medicare considers unbundling a major compliance violation and says ignorance is no excuse: It's each practice's responsibility to stay up-to-date on the latest coding initiative. But sorting through 2004's final National Correct Coding Initiative (NCCI) release, which adds almost 600 new edits, can prove time-consuming.

Read what our experts say about the edits that matter to otolaryngology practices. You can avoid submitting improper claims if you code based on these guidelines.

1. Don't Report Same-Day Hospital Consult and Admission

NCCI 10.3 confirms a Medicare consultation rule: You shouldn't bill a consultation when your otolaryngologist assumes patient care. The latest version bundles inpatient consultations (99251-99263) into same-day admission and discharge observation services (99234-99236, Observation or inpatient care ... including admission and discharge on the same date).

Good news: The edits make sense. "You wouldn't charge both a consultation and observation services," says Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Brick, N.J.

NCCI makes an observation admission mutually exclusive with an inpatient consultation because the otolaryngologist either manages the patient's care (observation) or offers his opinion (consultation). Here's how to report each:

  • If an otolaryngologist admits and discharges a patient from observation on the same day, you should code a same-date observation admission and discharge (99234-99236).

  • If a physician performs the three consultation R's (request, render, report) on an inpatient, assign an inpatient consultation (99251-99255, Initial inpatient consultation ...).

  • When the otolaryngologist offers follow-up consultation services, use 99261-99263 (Follow-up inpatient consultations for an established patient ...).

    2. Include Fluoroscopic Guidance in Cyst Injection

    Starting Oct. 1, you'll also want to avoid reporting fluoroscopic guidance in addition to a thyroid cyst aspiration or injection. Code 60001 (Aspiration and/or injection, thyroid cyst) now includes 76003 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]).

    Reason: NCCI considers fluoroscopic guidance an integral part of the aspiration procedure, Cobuzzi says. Fortunately, otolaryngologists don't need to worry about this bundle.

    Otolaryngologists don't use fluoroscopic guidance to locate the injection or aspiration site. They instead palpate the patient's thyroid during an office exam.

    3. Avoid Audiometry With Cochlear-Implant Check

    NCCI also continues its trend of creating numerous evaluative and therapeutic services bundles. In the latest version, NCCI targets the audiological function test section and bundles 31 audiometric tests (92552-92557, 92561-92589, 92596-92597) into 92601-92604 (Diagnostic analysis of cochlear implant ...).

    Luckily, these edits shouldn't hurt your otolaryngologist. The American Speech and Hearing Association (ASHA) saw "no need to contest" the edits, says Mark Kander, director of healthcare regulatory analysis at ASHA. Audiologists very rarely perform the bundled audiometric tests during cochlear-implant follow-up visits.

    Bonus: You can report same-day speech and language evaluation and treatment. NCCI 10.3 eliminates the speech-language evaluation (92506) and treatment bundle (92507-92508). Clinical experts had reported that the edit was inappropriate.

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