Otolaryngology Coding Alert

How to report two new codes for these procedures 
 
Good news: You'll save time and earn more money filing claims for hyoid suspension and gold weight placement in 2004 because you'll no longer have to submit all the paperwork for unlisted-procedure codes.

1. Use 21685 for Hyoid Suspension
 
Thanks to CPT 2004, you'll finally have a specific code for hyoid suspension (21685, Hyoid myotomy and suspension), which will eliminate paperwork and improve your pay for sleep apnea services. You previously should have reported the procedure with unlisted-procedure code 21899 (Unlisted procedure, neck or thorax), says Charles F. Koopmann, MD, MHSA, professor and associate chair of the department of otolaryngology, physician billing director, and a member of the faculty group practice at the University of Michigan in Ann Arbor. That meant you had to submit documentation with the claim, as well as a letter describing the procedure and the amount of physician work involved in it. Plus, you had to rely on the insurer to determine an appropriate charge.
 
Rather than allowing insurers to determine how much to pay for hyoid suspension, you'll be able to anticipate receiving more than $1,103.47 per procedure based on the National Physician Fee Schedule, which values 21685 at 31.42 facility relative value units (RVUs) ($35.12 per RVU [2004 conversion factor] x 31.42 RVUs = $1,103.47).
CPT's addition of 21685 is a big deal for otolaryngologists who specialize in treating obstructive sleep apnea, because sleep apnea physicians perform hyoid suspension quite extensively, says Andrew Borden, CCS-P, CPC, CMA, department of otolaryngology and communication sciences reimbursement manager at Medical College of Wisconsin in Milwaukee.  
 
Be careful: You may expect to find 21685 in the laryngeal section. But, CPT placed the new code in the neck subsection of the musculoskeletal system, Borden says.  Because the operation advances the tongue base and epiglottis forward, which opens the breathing passage at this level, hyoid suspension is often associated with the palette area, not the neck or soft tissues, he says.

2. File Gold Weight Placement With 67912

You will also no longer need to use an unlisted-procedure code for gold weight placement. New code 67912 (Correction of lagophthalmos, with implantation of upper eyelid lid load [e.g., gold weight]) will replace 67999 (Unlisted procedure, eyelids) and 67911 (Correction of lid retraction), which the Academy of Otolaryngology-Head and Neck Surgery formerly recommended.
 
Although new code 67912 will make coding lagophthalmos with gold weight placement easier and more consistent than before, ancillary-cost concerns over the gold weight supply may still occur, Borden says. For instance, if your otolaryngologist performs 67912 (26.52 RVUs) in the office, the majority of insurers will probably follow Medicare's lead and include the gold weight supply in the operation's global surgical package.
 
Remember: Codes 21685 and 67912 don't take effect until Jan. 1. To avoid denials for carriers that haven't entered the codes in their systems, consider informing your insurers that you intend to file claims for hyoid suspension and lagophthalmos with gold weight placement using the new codes starting Jan. 1, 2004. As always, make sure your documentation supports your billing.