Otolaryngology Coding Alert
Appeal for Payment if LCD Support Spirometry Diagnosis
Question:My records indicate that spirometry is a coverable CMS expense, but we cannot get Medicare to reimburse for it. The denials state that COPD/pulmonary dysfunction and chronic bronchitis are not coverable. My CMS sheet states that is exactly what the test is covered for. What should we do?
Colorado Subscriber
Answer: When you say “CMS sheet,” we assume you mean the LCD (local coverage determination) for your carrier. That’s what you need to refer to in terms of a procedure’s medical necessity. If your LCD states that your diagnoses (such as 496.x, Chronic airway obstruction, not elsewhere classified, or 491.x, Chronic bronchitis) are covered, include a copy of that information when you appeal the non-payment.
Otolaryngology Coding Alert
- Neck Procedures:
Learn the Ins and Outs of Neck Dissection Coding
Here’s your quick refresher on what each procedure involves. If your otolaryngologist documents that he [...] - Terminology Check:
Brush Up on These Familiar Neck Dissection Terms
Understanding anatomy always helps you code more accurately. Because neck dissections can involve a wide [...] - ICD-10:
Understand the Different Types of Sinusitis to Code Correctly
Heads up: Watch for varying definitions among groups. Sinusitis is a common condition for otolaryngologists [...] - Anatomy Refresher:
Do You Know Where Your Sinuses Are?
Learn skull structure to remember which is which. The paranasal sinuses are located within the [...] - Reimbursement:
CMS Could Start Paying MDs Based on Quality, Not Numbers of Procedures
Changes could be implemented as soon as late 2016. If the Department of Health and [...] - Reader Question:
Remember Edits Normally Bundle 12042 and 11420
Question: We billed CPT® codes 12042 and 11420 with modifier 51. I billed the 12042 as [...] - Reader Question:
69220 Could Work for Bilateral Cholesteatoma Removal
Question: One of our patients comes to the office every three or four months for [...] - Reader Question:
Appeal for Payment if LCD Support Spirometry Diagnosis
Question:My records indicate that spirometry is a coverable CMS expense, but we cannot get Medicare [...] - Reader Question:
There's No Need to Remove PQRS Codes from Secondary Insurer's Claim
Question: If we submit G codes (PQRS codes) to a patient’s primary insurer, should we [...] - You Be the Coder:
Coding for Percutaneous Vocal Cord Injection
Question:Our physician wants to inject Radiesse through the patient’s neck into the vocal cord with [...]
