Otolaryngology Coding Alert
Modifier -50 Is Payer-Specific
Question: On a bilateral procedure, should we bill the procedure twice with one procedure appended with modifier -50 and the other one with no modifier? Kansas Subscriber Answer: The answer depends on the insurer. Medicare and some carriers insist on one line, such as: Many private payers prefer two lines, for example: For these payers, billing on two lines will cause the carriers to reject the second code as a duplication of services, and carriers will reimburse the first code only (that is, they will pay only for a unilateral procedure). You should check with your payer and get its guidelines in writing to avoid denials and to ethically maximize reimbursement. If you can't get the carrier's rules in writing, track how explanation of benefits comes in and how payers want the claims. Keep a grid of the codes with each carrier's coding preferences and any other payer-specific information, such as global surgical periods.
Otolaryngology Coding Alert
- Answer Five Questions to Determine the Appropriate Trach Code
Reviewed on May 21, 2015
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By following five tips to report the appropriate fourth- and fifth-digit asthma codes, you can [...] - Answer Three Questions to Resolve 99211 Payment Issues
By reviewing who performed the service, the service performed and the associated diagnoses, you can [...] - Reader Question:
Bill Injections Based on Supervising Physician
Question: When administering shots to a patient whose physician is on vacation, should I bill [...] - Reader Question:
Use Determines Poisoning/Reaction Diagnosis
Question: An allergy patient on prednisone presented with nervousness, a headache and high blood pressure. [...] - Reader Question:
CCI Bundles Nebulizer Treatment,Training
Question: Does 94060 include the breathing treatment, or should I report a separate code, such [...] - Reader Question:
How to Code for Injection With Supplied Serum
Question: We have a patient who receives allergy injections at our otolaryngology office during the [...] - Reader Question:
NPP Rules Affect E/Ms in the Hospital,Not Office
Question: I've heard that CMS issued a memorandum regarding new nonphysician practitioner (NPP) guidelines. My [...] - Reader Question:
Know Serum Preparation,Administration Rules
Question: How should I charge 95165 for an immunotherapy allergen kit? We make a kit [...] - Reader Question:
Use Allergy for Primary Diagnosis
Question: How should I code the diagnosis for allergy shots? Should I report V07.1 for [...] - Reader Question:
Injections Include Needles
Question: Should I bill for the needles used during allergy injections? Michigan Subscriber Answer: The [...] - You Be the Coder:
Use Keywords to Select Laryngoscopy Code
Test your coding knowledge. Determine how you would code this situation before looking at the [...] - Reader Question:
Bill Vestibular Test Per Irrigation
Question: When my audiologists perform two warm and two cold calorics, they bill four units [...] - Reader Question:
Modifier -50 Is Payer-Specific
Question: On a bilateral procedure, should we bill the procedure twice with one procedure appended [...] - Reader Question:
Provider, Payer Determine Nerve Monitoring
Question: When an otolaryngologist performs facial nerve monitoring in an outpatient setting for 69641 (Tympanoplasty [...]
