Otolaryngology Coding Alert

Answer: CPTdoes not contain a code for hyoid suspension, which otolaryngologists use to treat obstructive sleep apnea. Consequently, you should report the procedure with unlisted-procedure code 21899 (Unlisted procedure, neck or thorax), says Charles F. Koopmann, MD, MHSA, professor and associate chair of the department of otolaryngology, physician billing director, and a member of the faculty group practice at the University of Michigan in Ann Arbor.

Although using an unlisted-procedure code may make payment difficult, assigning a code that does not describe the operation is inappropriate and fraudulent, he stresses. To improve reimbursement, contact the carrier for precer-tification and predetermination. If the insurer refuses coverage, collect cash up front from the patient. For payers who approve coverage, submit documentation with the claim and allow the insurer to calculate the fee. You should also include a description of the procedure and the amount of physician work involved in it.

The description should explain hyoid suspension in layman's terms to the payer. Therefore, understanding hyoid suspension basics is crucial to reimbursement. The operation advances the tongue base and epiglottis forward, which opens the breathing passage at this level.

To perform the procedure, the otolaryngologist makes an incision in a convenient skin crease in the upper neck. He or she then detaches two tendons on the upper surface of the hyoid bone, located just above the thyroid cartilage or "Adam's apple," and some of the muscle on the lower surface. Consequently, the hyoid can be advanced over the thyroid cartilage and secured in position.