Otolaryngology Coding Alert

Bill 69801 more than once per day, and you'd be throwing away a potential $202 pay.

Having problems with patient complaints when billing 69801 lately? Are your payers not paying for subsequent injections after the first? If you didn't catch how 69801's global days shifted to zero from 90 days, then you might find yourself ensnared in confusion between patient, payers, and your practice.

Examine the scenario described by Ann Blake, CPC, which describes the current problem that other coders commonly encounter:

Scenario: We billed labyrinthotomy (a.k.a. gentamicin injection) on a patient who got five injections on different visits. The patient has filed a complaint to the Department of Justice, stating that when she began gentamicin treatments, on the first day, the physician made an incision in her inner ear, and inserted a tube into which he administered gentamicin drops. On four subsequent visits, the physician used a needle to perfuse the drops into the middle ear through the tube. On the claim, we reported 69801 five times (one time for each service, listing each date of the visit) and the J code for the gentamicin, J1580 times the appropriate number of units for each date of service.

Conflict: The patient disagrees with the charges for four additional labyrinthotomies when the physician merely perfused drops into the ear. The doctor's office maintains the bill reflects the procedures that took place.

Which side is correct? The following clues should lead you to the right answer.

Clue 1: 69801 Applies To Perfusion Treatment, As Well As Labyrinthotomy

Codify (https://www.aapc.com/codes/) categorizes 69801 (Labyrinthotomy, with perfusion of vestibuloactive drug[s]; transcanal) under the surgery/operating microscope section. It also describes labyrinthotomy as a surgical incision into the labyrinth (the inner ear). However, the code's physician responsibility part specifically states that "69801 can also be used with in-office procedures because it includes perfusion of drugs. For example, if a transtympanic injection of a steroid is done in the office, with no incision, it is a perfusion treatment of the inner ear and should be coded with 69801."

Although 69801 has traditionally applied to gentamicin injections for Meniere's disease (386.00-386.04), you can also use the code to apply to steroid injections for Meniere's disease, autoimmune inner ear disease, and sudden hearing loss.

As in the case of the given scenario, labyrinthotomy procedures usually require several treatments, and you should report 69801 only once per day. For this year, however, you should be extra careful when billing 69801 because the code now carries a zero-day global period (from the original 90 days), reminds Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J.

What's the catch: This change on the number of global days means you can now report subsequent perfusions separately if performed on different dates. Don't forget to include the drug supply code when reporting subsequent perfusions. "This was important, because it was difficult to report the drug when a physician administered subsequent injections during the global period prior to this change," Cobuzzi adds. This is no longer a problem, because now you have access to a billable injection CPT® and a drug J code for each injection administration.

"You can pull up the global days for 69801, and it will show it has zero," reaffirms Julie Keene, CPC, CENTC, otolaryngology coding and reimbursement specialist, UC Department of Otolaryngology-Head and Neck Surgery in Cincinnati, OH. Billing the code one unit per visit (as indicated in the scenario) should not pose any problem as long as you document your claim properly.

"Patients who get gentamicin treatments have to remain in the office for at least 15-20 minutes after every injection to be monitored before they can leave. That is time and money to the practice, hence why this code has a relatively high RVU," Keene explains. You will notice that the new 2011 RVUs for 69801 are about one third the value of the 2010 RVUs with the change to zero global days.

Fee Schedule: You should expect a payment of $201.82 (5.94 RVUs multiplied by the 2011 conversion factor of 33.9764) when the doctor performs 69801 in a nonfacility setting.

Some would argue on using modifier 52 (Reduced services) for 69801 subsequent visits, but you actually don't need the modifier. "CPT® 69801 may or may not include the tube, so modifier 52 is not included," says Cobuzzi. For some services you do more work (for example, putting in the tube which cannot be charged separately), and for some services the work is less. The RVUs are based on averages, she adds.

The American Academy of Otolaryngology/Head and Neck Surgery has posted a guidance article for coding and billing these labyrinthotomy services to assist you whenever you run into any problems such as encountered by Ann. To access the letter, you can go to: http://www.entnet.org/Practice/CPT4ENT69801.cfm#.Tp9DNUjeNrc.facebook.