Otolaryngology Coding Alert

Question: When a patient with advanced head/neck carcinoma and advanced dental disease requires radiation, I routinely extract severely carious teeth following panendoscopy. As an otolaryngologist/head and neck surgeon, how should I code simple dental extractions?

Ohio Subscriber

Answer: You should use 41899 (Unlisted procedure, dentoalveolar structures). After submitting the claim electronically, send the insurer a cover letter stating that CPT doesn't restrict codes to certain specialties. Explain that head and neck surgeons take care of all areas of the head and neck including extracting teeth when the otolaryngologist deems the procedure medically necessary.

Some payers, however, may not cover the charges. One otolaryngology coder estimates that 60 percent of insurers pay dental extraction claims.

To ensure payment, precertify the extractions when possible. If the insurer rejects coverage or doesn't precertify operations, inform the patient that he will be responsible for any extraction charges. Either collect payment from privately insured patients at the time of service or balance bill them.

Have Medicare patients sign an advance beneficiary notice (ABN) explaining that Medicare may not cover the extractions. To indicate that you obtained an ABN, append modifier -GA (Waiver of liability statement on file) to 41899.