Otolaryngology Coding Alert

Question: How should I report removal of all four of the parathyroid glands with one partial reimplantation that took more than three hours?

Alaska Subscriber

Answer: Your use of 60500 (Parathyroidectomy or exploration of parathyroid[s]) is the same whether the physician removes one or four glands, or even none if your ENT is just exploring. It is the same payment and same coding. If your ENT performs an autotransplantation, you also bill the add-on code, +60512 (Parathyroid autotransplantation [List separately in addition to code for primary procedure]).

But if your ENT performs a thyroidectomy in addition to the parathyroidectomy, you should not bill 60500 because Medicare bundles it with all of the thyroidectomy codes, such as 60240 (Thyroidectomy, total or complete).

Modifier 22: If the amount of time represents an increased service and your ENT's operating note can show this (compare the actual time -- which must be documented -- to the scheduled time in the operating room, for instance), then by all means bill with modifier 22 (Increased procedural services) and raise your fee.

Be specific: To argue more effectively that a claim was truly "increased" -- and therefore deserving of modifier 22 and the additional reimbursement that comes with it -- you-ll want the claim's documentation to be as specific as possible. Consider these factors:

- Time: Time is quantifiable, making it easier for a carrier to convert into additional reimbursement.

Example: Statements such as "200 percent more time than usual was required to remove the parathyroid glands because of the patient's obesity, making the total procedure 90 minutes instead of 30 minutes" can be effective.

- Blood loss: Document the quantity of blood lost during the procedure, and compare it to what the typical patient loses during the same type of procedure.

- Special instruments: Compare the instruments and equipment used to perform the procedure to those typically used (if different).

- Technique: Clearly indicate when there has been a change in technique during the procedure and, more importantly, why.

Example: "Due to extensive adhesions, the physician had to convert the endoscopic procedure to an open procedure."

Cost-effectiveness: You may find the time and effort involved in documenting modifier 22 to cost as much as the reimbursement you finally receive from an insurer.