Otolaryngology Coding Alert

Profit as much as $100 if you can readily identify 40806's purpose.

When coding for frenulum release, the first thing you should do is keep your vocabulary straight. Sometimes, physicians tend to mislabel the procedure on their operative note, so you should carefully read the note, and pay attention to these key anatomical structures:

• Labial -- associate with lip
• Lingual -- think linguistics; under the tongue (language + tongue).

Your clues do not end there. You can learn more by differentiating the procedure that your physician performs. Here's how:

Clipping (Fenotomy) and Removal (Frenectomy) Spells The Difference

The method of frenulum repair should give you some clues, too. For instance, CPT®s 40806 (Incision of labial frenum [frenotomy]) and 41010 (Incision of lingual frenum [frenotomy]) describe the procedure frenotomy wherein the otolaryngologist clips the labial/lingual frenulum, sometimes needing more than one cut to release the upper lip/tongue.

On the other hand, CPT®s 40819 (Excision of frenum, labial or buccal [frenumectomy, frenulectomy, frenectomy]) and 41115 (Excision of lingual frenum [frenectomy]) involves more than just simple clipping. The physician removes the thin band of tissue (frenum) under the tongue or in the upper lip. The condition is known as tongue tie if the frenum is lingual, and lip tie if the frenum is labial.

Check out this scenario: A patient presents with a short upper labial frenulum with binding of the upper lip. The physician performs a release of the labial frenulum. How should you report the procedure and diagnosis?

Code it: Since the procedure entails a release of the labial frenulum, you would code 40806. You can use 744.9 (Unspecified congenital anomalies of face and neck) to report the diagnosis.

Reimbursement: For 40806, you can expect a Medicare nongeographic adjusted payment of about $104.65 (3.08 RVUs multiplied by the 2011 conversion factor of 33.9764).

41115 Determines Your Ankyloglossia Frenectomy Claim

Say this time the physician performs surgical alteration of a short frenulum to correct the patient's ankyloglossia, freeing the tongue and allowing greater range of motion. In this case, you should report 41115 to describe the procedure, then link 750.0 (Tongue tie) for the diagnosis.

Red flag: Most payers cover surgery of the lingual frenulum when it is medically necessary, and when the procedure is consistent with symptoms and confirmed diagnosis of the patient's illness (i.e., the tongue-tip cannot extend upward to the posterior alveolar ridge and/or the patient experiences significant dysfunction in feeding or speaking). Ensure that your medical record documentation includes these important details.