Otolaryngology Coding Alert

Question: This is an operative report on a lesion of the cheek that my otolaryngologist attempted to excise: The doctor was trying to remove a lesion in the patients cheek but it was difficult to palpate. A lacrimal probe was placed into the parotid duct and the lesion localized on the outside and a small incision made parallel to and inferior to the parotid duct intraorally. Soft tissues were separated, separating in the direction of the fibers of the facial nerve and parallel to the parotid duct. A needle was placed into the lesion, palpated externally and traced intraorally. Using this as a guide, the dissection separated the tissues no lesion could be identified. There was a lot of fatty tissue, and removal of the needle and palpation several times through the procedure did not allow localization of the lesion. The patient was then placed in a sitting position; again, attempted localization of the lesion was unsuccessful. Rather than risk a more extensive dissection because of patients history of non-Hodgkins lymphoma, the procedure was terminated.
 
Given the time and effort involved, shouldnt more than just a removal of lesion code be billed?

Mississippi Subscriber
 
 
Answer: The appropriate excision of lesion code should be billed with two modifiers appended. First, modifier -53 (discontinued procedure) is added to indicate that the procedure was terminated before completion. Second, modifier -22 (unusual procedure services) should be appended to indicate that the procedure took significantly more effort than a typical lesion excision. To support a modifier -22 claim for more reimbursement, the otolaryngologists documentation should include a separate section that indicates why the procedure was more complicated, as well as start and stop times. Simple language should be used to convey successfully the reasons to non-medical carrier claim reviewers. Coding specialists recommend that in this situation, the carrier (preferably, someone in authority who is familiar with otolaryngologic issues) should be contacted before the claim is submitted.