Otolaryngology Coding Alert

Before you file another vocal cord injection claim, run though this checklist to make sure you don't leave dollars on the table.

If the otolaryngologist uses laryngeal electromyography (LEMG) for guidance, you may also report +95874-(Needle electromyography for guidance in conjunction with chemo-denervation [list separately in addition to code for primary procedure]). "Payers should reimburse both chemodenervation and EMG for localization when performed together," according to the American Academy of Otolaryngology -- Head and Neck Surgery.

Tip: Good documentation on needing LEMG due to difficulty determining the proper injection site will help overturn denials due to diagnostic (95874) with surgical (64613) code reporting.

Append modifier 26 (Professional component) for non-office LEMG.

Example: An ENT injects Botulinum toxin type A (Botox) directly into a hospital outpatient's neck using LEMG to identify the affected muscles. Because the physician does not own the equipment, report the LEMG as 95874-26.

If your otolaryngologist performs percutaneous injection in the office (place-of-service code 11) with practice-purchased Botox, you should code the supply with J0585 (Botulinum toxin type A, per unit) and indicate the number of units in Item 24G on the CMS-1500. For percutaneous injection in the hospital outpatient facility (POS code 22) or an ambulatory surgical center (POS code 24), the facility purchases the Botox and bills for it.

Medicare also allows you to bill wasted Botox supply. To indicate the number of units wasted, append modifier JW (Drug amount discarded/not administered) to J0585.