Otolaryngology Coding Alert

Question: How should I report a nasal culture when the otolaryn-gologist suspects that the patient has MRSA?

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Answer: When a definitive diagnosis is not available, you should report the patient's signs and symptoms. Your physician suspects that the person has methicillin-resistant Staphylococcus aureus (MRSA). The nasal swab is for a screening of the suspected disease. Until you have those results, you should not use an MRSA diagnosis (038.11, Staphylococcus aureus septicemia). The patient probably exhibits some signs and symptoms, such as nasal congestion (478.1, Other diseases of upper respiratory tract; other diseases of nasal cavity and sinuses), which you should link to the CPT code for collecting the specimen.

Because the laboratory analyzes the nasal pharyngeal swab test, you cannot code for it. But you may include the work involved in taking the swab in the medical decision-making. If your otolaryngologist carefully documented the medical decision-making that led him to perform the swab, it could bump the E/M to the next level.

In addition, physicians may recoup the cost of obtaining, handling and conveying a specimen to a laboratory with 99000 (Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory). You may use the code to collect money for additional physician-incurred transportation costs, such as expedited service. In addition, 99000 reflects the costs of preparing the specimen.

Medicare considers 99000 a bundled service and makes no separate payment for it. Some commercial payers may cover the service.

Answers to You Be the Coder and Reader Questions reviewed by Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J.