Wiki ENT Coding question/Urgent

[jsd123]

Hi!

OK--first, the setting is outpatient surgery in the HOSPITAL; in this scenario when billing for BOTH physician AND facility, I just use CPT codes? Is that what you're saying?

Second the note just states: "left frontal sinus endoscopy, exploration & removal of diseased tissue" (just like CPT code 31276 states); "bilateral anterior & posterior ethmoidectomy" (just like CPT code 31255 states); and "bilateral maxillary antrostomy" (just like CPT code 31256 states)

This payer DOES require the "51" if it is aplicable! Sooo...I need to know if it is correctly applied for the physician portion?

FINALLY...for my info...if the Volume 3 codes never get modifiers applied, first how does one indicate bilateral & multiple procedures? second what are the "hospital approved modifiers" for? Now I'm totally confused!

Thanks SO Much!

Janice

 

[mitchellde]

Ok the hospital modifiers are for CPT only. CPT is used for physician and outpatient coding only. If this is an op note there must be more information in the body of the note. I am having trouble with the scenario in terms of bundleing with out the procedure note itself.

 

[jsd123]

NEEDED: Final Clarification ENT OP Surgery Question

Ok the hospital modifiers are for CPT only. CPT is used for physician and outpatient coding only. If this is an op note there must be more information in the body of the note. I am having trouble with the scenario in terms of bundleing with out the procedure note itself.

OK--let me see if I have this straight?

1) For a procedure in outpatient surgery, both the physician AND facility use CPT codes?

2) Volume 3 procedure codes are never used in outpatient surgery, hospital?

3) The physician would append Modifier "51" to multiple procedures (in his/her professional billing?)

Sooo...what does the facility use to indicate multiple procedures in this outpatient surgery case at their site?

 

[mitchellde]

The facility does not need to indicate multiple surgeries, it is just one of the many differences in billing. For the facility claim the second and subsequent procedures are auto discounted and would need a modifier to make that not happen.