Otolaryngology Coding Alert

You'd better put learning CPT 2010's new skin repair code bundles at the top of your list of New Year's resolutions to keep denials, lost reimbursements, and fraud charges at bay.

CPT 2010 new codes 14301-14302 (Skin tissue rearrangement) received the brunt of the Correct Coding Initiative (CCI) version 16.0's edits.

Codes 14040-14041 (Tissue transfer closure) and 14060-14061 (Adjacent tissue transfer) are components of 14301 (Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm) as of January 1. "These are similar services and should not be coded together," says Pamela J. Biffle, CPC, CPC-I, CCS-P, CHCC, CHCO, owner, PB Healthcare Consulting and Education, Inc. in Watauga, Texas.

You will be able to separate the edits with a modifier (such as 59, Distinct procedural service) in some situations, such as rearrangements on different areas, as appropriate. You code adjacent tissue transfers once per defect, no matter how many flaps are used, explains Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CENTC, CHCC, president of New Jersey-based CRN Healthcare Solutions.

Don't miss: Watch out for edits bundling 14301-14302 into 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) and 96374 (Intravenous push, single or initial substance/drug). Code 14301 also includes many additional procedures (for a quick reference sheet, see "Bundle Tissue Transfers with Debridement, Repair, and More" on page 2).

If you haven't been including J2001 (Injection, lidocaine HCl for intravenous infusion, 10 mg) in 14301, make sure you do so. The local anesthesia is always included in any integumentary code. Now, CCI has formalized this bundle that previously existed only as a matter of convention, comments Cobuzzi.

You can forget coding for two procedures when your otolaryngologist provides them in addition to tumor excision.

Including 12001-12007 (Simple repair of superficial wounds) as part of the new tumor excision codes (21011- 21014) "makes perfect sense," says Randall Karpf, coding consultant with East Billing in Connecticut. "A simple repair can be done during the course of the excision, so you'd bundle it unless the separate encounter or site rules apply."

If your surgeon extensively debrides an area prior to tumor excision, be prepared to drop the debridement code from the claim. CCI 16.0 bundles debridement codes (11010-11012, Debridement including removal of foreign material associated with open fracture[s] and/or dislocation[s]; skin and subcutaneous tissue, muscle fascia, muscle, and/or bone ) with many muscoskeletal  xcision codes. For instance, 21014 (Excision, tumor, soft tissue of face or scalp, subfascial; 2 cm or greater) now includes fracture debridement codes 11010-11012.