Otolaryngology Coding: Physicians Will Finally Get Paid For Crp Coding

This year, CPT brought good news for ENT coders. Finally, physicians will get paid for canalith repositioning procedure (CRP) coding after a two-year struggle.

When we look back, CPT 2009 excited ENT coders with new CPT code 95992. However the 2009 Medicare Physician Fee Schedule played spoilsport. CMS assigned the codes ‘B' status or bundled it always, making payment for CRP or the Epley maneuver using the new code impossible to get.

However the fight for payment of CRP came to an end because of the 2011 Medicare Physician Fee Schedule.

Note: If the ENT carries out and documents a medically necessary E/M that's significant and separately identifiable from the CRP, add modifier 25 to the evaluation & management service. What's more, Medicare doesn't allow payment for audiologists performing therapeutic procedures, such as CRP.

2011 CPT dictates you can use the code closet to the documented time. And this advice is nothing new. Your documented time must be equal to or exceed the average time given to bill that level. Your documented time must be equal to or get past the average time provided to bill that level. For a 35 minutes spent on a medically necessary counseling-dominated visit is a 99214, per CPT you could report 99215.

If the ENT carries out and documents a medically necessary E/M that's significant and separately identifiable from the CRP, add modifier 25 to the evaluation & management service. What's more, Medicare doesn't allow payment for audiologists carrying out therapeutic procedures, such as CRP.

Always Medicare has taken the times indicated in CPT's code descriptors to represent minimums. The doctor would opt for the lower code unless the time was greater than or equal to the higher-level code's required time.

So will Medicare change its position? At this juncture, it's not sure.

Otolaryngology Coding: How To Report Fungal Sinusitis

Your otolaryngology coding practice throws open many challenges and presents a lot of questions. Say for instance you may be asking yourself questions like "Is there a specific diagnosis code for fungal sinusitis?"

Well, even though looking up "Sinusitis: due to: fungus, any sinus" in the Alphabet Index, Volume 2 of ICD-9-CM directs you to "117.9," a single code does not describe fungal sinusitis. You should instead use a combination of ICD-9 codes to represent the condition.

According to the initial instruction for category 110-118, Mycoses, you should use additional code to identify manifestation. List the chronic or acute sinusitis for the primary diagnosis. After this code the underlying fungal infection as the secondary diagnosis.

The following steps will tell you how:

One: Report the proper sinusitis code for sinus membrane lining inflammation. Code 461.x for acute sinusitis. For chronic sinusitis (frequent or persistent infections lasting more than three months) report 473.x. select the fifth-digit code based on where the sinusitis takes place.

For instance, for ethmoidal chronic sinusitis, you should choose Code 473.2 (Chronic sinusitis; ethmoidal).Most likely, your otolaryngologist will prescribe a decongestant, pain reliever or antibiotics to treat sinusitis.

Two: Report the ICD-9 code that represents the fungal infection. Category 117 lists various types of mycoses that offer a more specific diagnosis than 117.9 (Other and unspecified mycoses).For example, think that a patient has chronic ethmoidal sinusitis due to aspergillosis (117.3), an infection that can affect the sinuses and is caused by inhaling the fungus aspergillus, which is found in compost heaps, air vents and airborne dust. You need to enter 473.2 as diagnosis 1 and 117.3 as diagnosis 2 in Box 21 of the CMS-1500 form.

Even though the otolaryngologist may treat aspergillosis with antifungal drugs, such as amphotericin, itraconazole or voriconazole, some forms of aspergillus oppose these drugs. Therefore the physician may need to treat the patient with caspofungin, a newer antifungal drug. Your otolaryngologist can tend to more serious aspergillosis cases in the sinuses by scraping out the fungus and applying antifungal drug drops.

ICD-10: For Sensorineural Hearing Loss, exercise H code use

How would you go about second-time diagnostic analysis?

The most frequent diagnosis for cochlear implant patients is 389.10 (Sensorineural hearing loss, unspecified). This condition is normally due to lesions of the cochlea and the auditory division of the eighth cranial nerve. When ICD-9 switches to ICD-10 in October 1, 2013, you will have to shift to coding sensorineural hearing loss using the code H90.5 (Unspecified sensorineural hearing loss).

ICD-10 difference: You would not have to make any adjustment to change to the ICD-10 code as the conversion will offer no difference in the code's function. Also, you should notice that 389.10 and H90.5 have the same descriptors.

Otolaryngology coding tips: Think that a patient had cochlear implant surgery, and your otolaryngologist carried out diagnostic analysis. But then this first surgery failed, and the patient underwent a second surgery. You should go for the second round of diagnostic analysis with the same CPT codes you must have used to report the first one: 92601-92604 (Diagnostic analysis of cochlear implant ...).

You can either attach 389.10 or 389.18 (Sensorineural hearing loss of combined types) to the procedure code to describe the fitting diagnosis for bilateral sensorineural hearing impairment.

CI patients normally require analysis within six weeks postoperatively for the initial fitting. The patient goes back periodically during the first year for adjustments to the processor's stimulus parameters to figure out the signals going to surgically implanted electrodes in the cochlea.