Otolaryngology Coding Alert

Question: Is there anything I can do from a coding perspective to prevent 31231 bundling denials when performed with an evaluation and management (E/M) service?

Iowa Subscriber

Answer: As a coder, to a certain extent your hands are tied since your job is to exclusively translate the provider’s services into codes for the payer. However, keeping in constant communication with the billing department could help to streamline these services. If they make you aware that this particular code is frequently denied when billed alongside an E/M service, you can send the claim both electronically and on paper in anticipation of an electronic claim denial. You should work in conjunction with the billing department to make sure the paper claim includes all the necessary documentation, including operative report and chart/ physician notes, to help justify reimbursement for both services.

You can also work closely with your providers to ensure that the documentation supports the significant, separately identifiable evaluation and management (E/M) service along with the minor procedure note so that when appeals are sent in, the practice successfully demonstrates to the third-party payers that both the E/M and the endoscopy are payable. The billing department can also develop a templated appeal letter to streamline the appeal process for these regular denials.

Keep in mind that Mass Eye and Ear recently had to pay a large penalty to the Office of Inspector General (OIG) as a result of a whistleblower lawsuit claiming that the organization was improperly coding and billing E/M services with diagnostic nasal endoscopies and laryngoscopies. Without further details on the settlements, it is difficult to determine if the settlement was a result of improper charges or poor documentation.

Read more about the lawsuit here: https://www.justice.gov/ usao-ma/press-release/file/1388661/download