Otolaryngology Coding Alert

Question: A patient visits the otolaryngologists office regularly for massage of his temporomandibular joint dysfunction (TMJ). A massage therapist employed by the practice performs the service. Afterward, the otolaryngologist looks in on the patient and recommends he return in three weeks. Should 99211 be used to report the services provided by the otolaryngologist?

New Jersey Subscriber

 
Answer: TMJ massage therapy is often considered a non-covered service; thus, it should not be reported to the carrier but should be considered a cash service. It may be helpful to have the patient sign a waiver to signify that he understands the service is not covered and will have to be paid for out of pocket.
 
As for 99211 (office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services.), the physician may bill this code in this situation depending on the medical necessity for the encounter and, as always, the documentation. If the otolaryngologist documents the encounter and why it took place, it may be possible to bill 99211.
 
For example, if the patient has a chief complaint and the otolaryngologist evaluates and counsels the patient (and documents this face-to-face time), 99211 may be reported over and above the (cash only) massage. However, if the encounter consisted of little more than the otolaryngologist stopping in to say hello, no separate E/M visit should be reported.
 
If the otolaryngologist sees the patient, takes a history and recommends a treatment plan, the encounter is more often reported as 99212 (office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem focused history; a problem focused examination; straightforward medical decision making).

 
You Be the Coder and Reader Questions were answered by Jan D. Babcock, CMPE, administrator of Head and Neck Surgery Associates in Indianapolis, Ind.; Randa Blackwell, financial specialist with the Otolaryngology Division of the Department of Surgery at the University of Maryland in Baltimore; Andrew Borden, CPC, CCS-P, CMA, reimbursement manager for the Department of Otolaryngology at the Medical College of Wisconsin in Milwaukee; Susan Callaway, CPC, CCS-P, a coding and reimbursement specialist and educator in North Augusta, S.C.; 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.; Lee Eisenberg, MD, an otolaryngologist in private practice in Englewood, N.J., and a member of CPTs Editorial Panel and Executive Committee; Michelle Logsdon, CPC, CCS-P, a coding and reimbursement specialist in Toms River, N.J.; and Teresa Thompson, CPC, an otolaryngology coding and reimbursement specialist in Sequim, Wa.