Otolaryngology Coding Alert

This ammo will help you combat insurer's autotransplantation base-code snafu.

You can boost a claim involving 60240 by more than $240 when you meet 60512's criteria.

Reporting +60512 (Parathyroid autotransplantation [list separately in addition to code for primary procedure]) can add about $240 to a thyroidectomy claim (the Medicare Physician Fee Schedule assigns 6.55 total relative value units to 60512; 6.55 RVUs x 2010 conversion factor of 36.879 = $241.52).

But 60512 carries two requirements. Experts show you how to usurp one "R," removal of four glands, and how to avoid a common payment policy glitch involving the second "R," report with correct base code.

Use 60512 When ENT Removes 4 Glands

Before green lighting a claim for 60512, look for documentation that supports the full procedure. When the op report indicates the otolaryngologist performed only a portion of 60512, correct procedural terminology requires you to use a modifier.

Consider this scenario: Is it appropriate to code for 60240 (Thyroidectomy, total or complete) along with 60512 (autotransplantation of parathyroid gland), when only one parathyroid gland was removed?

Answer: When the surgeon removes one parathyroid gland for autotransplantation as in this example, you may still report 60512, but you'll need to use modifier 52 (Reduced services) to indicate a reduced autotransplantation. In 60512, "all four parathyroid glands are completely removed," according to the Coders' Desk Reference.

Best practice: "Leave the fee as it is," says Laureen Jandroep, OTR, CPC, CPCEMS, CPC-H, a CodeRyte coding analyst and senior instructor for New Jersey-based www.CodingCertification.org. Let the insurer reduce the payment.

Send in paperwork showing the reduced portion of 60512. Then the payer will adjust the fee based on the reduction, Jandroep says. Report 60512 With 60240-60271 Based on CPT Check that you can use 60512 as an add-on code with the main procedure you are reporting. The CPT manual lists all thyroidectomy codes (60240-60271) as appropriate base codes for 60512.

Anticipate Rejection on Non-Parathyroid Claims

Some payers restrict 60512's base code to parathyroidectomy codes (60500-60505). The Correct Coding Initiative (CCI), however, bundles parathyroidectomy codes with thyroidectomy codes (60240-60271). So you should never bill parathyroidectomy in addition to thyroidectomy, which makes appeals for incorrect base code denials challenging.

Example: An otolaryngologist performs thyroidectomy with radical neck dissection (RND), full parathyroidectomy, which requires autotransplantation of all four parathyroids. CCI bundles parathyroidectomy into thyroidectomy. So you code the thyroidectomy with RND (60254, Thyroidectomy, total or subtotal for malignancy; with radical neck dissection), not the parathyroidectomy (60500, Parathyroidectomy or exploration of parathyroid[s]). You also report +60512 for the autotransplantation of the parathyroids.

Because add-on codes by definition are modifier 51 (Multiple procedures) exempt, you use 60254 and 60512 with no modifier.

Problem: The payer's system edit inappropriately throws out 60512 with a denial of "incorrect base code." Tip: Use the parenthetical instruction following 60512 to show the payer appropriate base codes.

Use Letter to Appeal Improper Base-Code Edit

You should appeal 60512's denial with the following:

Dear Insurance Representative:

You have denied a claim for +60512 (Parathyroid autotransplantation [list separately in addition to code for primary procedure]) due to an incorrect base code. But CPT allows 60512 with a base code of 60254 (Thyroidectomy, total or subtotal for malignancy; with radical neck dissection) [or insert the thyroidectomy code the insurer denied]. The parenthetical instruction following 60512 in the CPT 2007 manual indicates all thyroidectomy codes are eligible for an add-on code of 60512. "Use 60512 in conjunction with 60500, 60502, 60505, 60212, 60225, 60240, 60252, 60254, 60260, 60270, 60271," states the AMA. To support our claim of 60254 and 60512, I have attached a copy highlighting the CPT 2010 manual's instruction.

In addition, the Correct Coding Initiative (CCI) does not allow us to report parathyroidectomy codes (60500-60505) with thyroidectomy codes (60240-60271). So when a surgeon performs a parathyroidectomy and thyroidectomy, we are unable to report a base code of 60500-60505.

Please alert the appropriate supervisors to this improper system edit involving appropriate base codes for 60512. Correcting these edits will save us all time in avoiding future denials for 60512 billed with thyroidectomy codes (60240-60271).