Otolaryngology Coding Alert

Question: An otolaryngologist monitored a patient's facial nerves during a parotidectomy. Once the parotidectomy was complete, he created a muscle flap to close the patient. Can we bill separately for the facial nerve monitoring or the muscle flap?

Nebraska Subscriber

Answer: The creation of the muscle flap is not included in the parotidectomy and should be reported separately with 15732 (muscle, myocutaneous, or fasciocutaneous flap; head and neck [e.g., temporalis, masseter, sternocleidomastoid, levator scapulae]). Some otolaryngologists forget to code for muscle flaps when they are created following neck surgeries, such as parotidectomies. By not coding the 15732 in the mistaken belief that it is included in the primary procedure, physicians are missing a reimbursement opportunity, since 15732 pays reasonably well (32.19 transitioned RVUs versus 17.56 RVUs for the parotidectomy, 42410, excision of parotid tumor or parotid gland; lateral lobe, without nerve dissection).
 
Facial nerve monitoring should not be billed separately. It is difficult to do so, because the most appropriate monitoring code, 95920 (intraoperative neurophysiology testing, per hour [list separately in addition to code for primary procedure]), is an add-on code that the CPT manual states may be used only with specific codes, none of which have anything to do with parotidectomy. In short, there is no code for facial nerve monitoring in this case, which is considered by most carriers as integral to the parotidectomy and, therefore, the RVUs assigned to the parotidectomy already take monitoring into account.