Otolaryngology Coding Alert

Update your Medicare study billing to 95867-59, 60500-60505

Starting April 1, you'll need to use modifier -59 to recoup electromyography payment with parathyroidectomies.

Thanks to the National Correct Coding Initiative (NCCI), version 10.2, parathyroidectomy codes 60500 (Parathyroidectomy or exploration of parathyroid[s]), 60502 (... re-exploration) and 60505 (... with mediastinal exploration, sternal split or transthoracic approach) now include 17 services. (See the chart "How to Add $25 or More to Your 60500, 64612, 92597 Claims" for a comprehensive list of the bundled codes.)

Concentrate on Monitoring, EMG Bundle

You'll mainly have to pay attention to two parathyroidectomy bundles: intraoperative testing (+95920, Intraoperative neurophysiology testing, per hour [list separately in addition to code for primary procedure]) and unilateral cranial nerve supplied muscle (95867, Needle electromyography; cranial nerve supplied muscle[s], unilateral). "We often bill 95867 in addition to 95920 with 60500-60505," says Asia Evans, coding specialist at Head and Neck Surgery Associates (seven otolaryngologists) in Indianapolis.

Private payers may reimburse for same-surgeon monitoring. But when the otolaryngologist who performs the parathyroidectomy also provides the monitoring, Medicare will not pay for 95920.

Many 95920 local medical review policies state that the carriers will not pay for monitoring unless another physician performs the service. "The edits make policy national," says Barbara J. Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions in Brick, N.J.

What's new: Third-party payers may follow NCCI and bundle 95920 with 60500-60505. More important, Medicare will no longer reimburse for the electromyography (EMG), which establishes a baseline for the otolaryngologist to use as a comparison during the parathyroidectomy, Evans says.

What You Should Do
 
You may append modifier -59 (Distinct procedural service) to 95867 if the nerve monitoring occurs at a separate session or body site, Cobuzzi says.

Why: You may use modifier -59 because the edits contain a "1" modifier. "That means NCCI permits you to bypass the edits with modifier -59 under appropriate circumstances," Evans says.

Example: To determine a paralysis patient's extent of damage, an otolaryngologist conducts a unilateral cranial EMG at a separate operative session. To avoid further nerve injury using the EMG baseline to compare the patient's pre-, during and postsurgery status, the surgeon monitors the nerve for 60 minutes during the parathyroidectomy.

Medicare solution: For the parathyroidectomy, you should report 60500. For the unilateral EMG study, you should assign 95867 with two modifiers. You should append modifier -26 (Professional component) to indicate that you are billing for the professional component only. To inform the payer that 95867 occurs at a separate session from 60500, you should append modifier -59 to 95867, Evans says.

If you don't use modifier -59 on EMG-parathyroidectomy claims, your carrier will deny 95867 payment, and you'll lose $44.06 in reimbursement for the EMG's professional component (-26).

Watch out: Did you notice that the Medicare solution omits 95920? That's because you shouldn't bill Medicare for intraoperative nerve monitoring. Since the same surgeon provides the monitoring and performs the operation, Medicare includes the monitoring in the parathyroidectomy.

Some third-party insurers, however, may separately reimburse same-surgeon monitoring. Therefore, when billing private payers, you should report the same codes as above (60500, 95867-26-59), plus 95920-26 for the monitoring. Because the surgeon performs 60 minutes of monitoring, you should assign one unit of 95920.