Otolaryngology Coding Alert

Appealing a 60512 denial can be tricky business,but don't give up.

Barbara Cobuzzi, MBA, CENTC, CPC-H, CPCP, CPC-I, CHCC, president of CRN Healthcare Solutions, Tinton Falls, N.J., shares a war story in which she untangled conflicting bundles.

-One of my memorable appeals with my Medicare carrier was a case where the doctor performed a thyroidectomy, parathyroidectomy, and parathyroid autotransplantation.

-I only billed the thyroidectomy -- 60240 (Thyroidectomy, total or complete) -- and the parathyroid autotransplantation -- 60512 (Parathyroid autotransplantation [List separately in addition to code for primary procedure]) -- because the  arathyroidectomy was bundled with the thyroidectomy.

-My Medicare carrier denied 60512. I appealed, but they said they had an edit in the system that denied pay for 60512 unless 60500 (Parathyroidectomy or exploration of parathyroid[s]), 60502 (-re-exploration) or 60505 (- with mediastinal exploration, sternal split or transthoracic approach) are also billed. So, I had to go to Fair Hearing (the predecessor to the qualified independent contractor [QIC] hearing) and make the point that, although 60500 was performed and shown in the operative note, it could not be coded or billed because it is bundled with the thyroidectomy. I won the appeal at the Fair Hearing.-

Code 60512 pays about $229 (6.35 transitional nonfacility total relative value units [RVUs]), using the 2009 Medicare Physician Fee Schedule and conversion factor of 36.066.

Brag on yourself a little: If you have a coding success story you-d like to share, please write editor Jim McBee at jmcbee@eliresearch.com.