Otolaryngology Coding Alert

New G codes from CMS give multiple options for evaluations.

If you’ve been seeing denials for FEESST (flexible endoscopic evaluation of swallowing with sensory testing) claims, it could be because you’re reporting the wrong codes. Read on to be sure you’re on board with the latest changes.

Look to HCPCS, Not CPT®, for Codes

In the past, you would report FEESST with either 92610 (Evaluation of oral and pharyngeal swallowing function) or 92614 (Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording). That began to change when Medicare introduced new FEESST codes in January 2013 with a six-month testing period.

The switch: The new codes that Medicare wants reported for FEESST are G codes found in HCPCS instead of CPT®. If you file a Part B claim for service on July 1, 2013, or after without the new G codes, Medicare will return the claim unpaid. (See the chart on page XX for a rundown of the G code choices.)

Think ahead: If a patient could potentially transition from Medicare Part A to Medicare Part B billing – or if the patient has Medicare Part B as a secondary insurance – include the appropriate G code and severity modifiers in the patient’s medical record. Noting these factors with every evaluation and every tenth treatment day will keep you consistent with Medicare guidelines and will allow for correct reporting if you ever bill Medicare Part B for the services.

Pair Codes With the Correct Severity Modifier

Each G code you list on the claim must be paired with a modifier indicating the severity or complexity of the patient’s condition (on a 7-point scale). These modifiers include:

• CH (0 percent impaired, limited or restricted), level 7
  
• CI (At least 1 percent but less than 20 percent impaired, limited or restricted), level 6
  
• CJ (At least 20 percent but less than 40 percent impaired, limited or restricted), level 5
  
• CK (At least 40 percent but less than 60 percent impaired, limited or restricted), level 4
  
• CL (At least 40 percent but less than 60 percent impaired, limited or restricted), level 3
  
• CM (At least 80 percent but less than 100 percent impaired, limited or restricted), level 2
  
• CN (100 percent impaired, limited or restricted), level 1.
  

Watch Whether You’re Required to Comply

Anyone providing therapy (including speech-language evaluation and treatment services) for Medicare Part B beneficiaries must report outcomes on the claim form as part of Medicare’s mandatory data collection program. This includes Part B services in:

• hospitals
  
• critical access hospitals
  
• private practices
  
• skilled nursing facilities
  
• home health or rehabilitation agencies
  
• outpatient rehabilitation facilities (ORFs)
  
• comprehensive outpatient rehabilitation facilities (CORFs).

Reporting requirements do not apply to Medicare Part A, Medicare Advantage/HMO plans, Medicaid, or private health plans.