2016 ADVANCED ENT SPECIALTY CODING SESSION c.ymcdn.com/sites/ · PDF file2016 ADVANCED ENT...

2016 AOA ENT Specialty Coding (KP)_082916 1

September 9, 2016

2016 ADVANCED ENT SPECIALTY CODING SESSION Sponsored by:

Association of Otolaryngology Administrators Annual Meeting Chicago, Illinois

Presented by:

Kim Pollock, RN, MBA, CPC, CMDP

[email protected] 312.642.5616 www.karenzupko.com


KIM POLLOCK, RN, MBA, CPC, CMDP CONSULTANT AND SPEAKER Nationally recognized otolaryngology

coding and documentation expert

Expert in analyzing chart documentation and in reengineering practices to enhance the reimbursement process.

Understands the complexity of coding and reimbursement issues specific to surgeons.

Improving the revenue cycle for practices having worked with hundreds of practices in her almost 20 years of consulting.

Former board member of both the Society of Otorhinolaryngology and Head-Neck Nurses and the Ear, Nose and Throat Nursing Foundation

Recipient of the Presidential Citation from the Society of Otorhinolaryngology and Head-Neck Nurses

Published coding book author, multiple articles

Co-author of "The Essential Guide to Otolaryngology Coding", Plural Pub.

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AGENDA


AGENDA

Ear:

• Tympanoplasty with and without Mastoidectomy

Nose:

• Endoscopic Sinus Surgery/ Balloon Dilation

Throat/Neck:

• Voice Procedures

• Laryngectomy with and without Neck Dissection

Facial Plastic/ Reconstructive

• Adjacent Tissue Transfer Codes

Skull Base Surgery

• Pituitary Tumor Removal

• Endoscopic Skull Base Surgery

• Excision of an Acoustic Neuroma

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EAR


ANATOMY

https://commons.wikimedia.org/wiki/Category:Middle_ear#/media/File:Blausen_0330_EarAnatomy_MiddleEar.png

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https://commons.wikimedia.org/wiki/File%3AAnatomyHumanEar.gif

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TYMPANOPLASTY CODES

CPT Code Description Comments

69631 Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction

Repair of tympanic membrane only; includes palpation of ossicles

69632 with ossicular chain reconstruction (e.g., postfenestration)

Includes repair hearing bone(s) using patient’s own/donor bone(s) graft material

69633 with ossicular chain reconstruction and synthetic prosthesis (e.g., partial ossicular replacement prosthesis [PORP], total ossicular replacement prosthesis [TORP])

Requires fixing hearing bone(s) with synthetic prosthesis

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CASE: TYMPANOPLASTY

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CHL H90.11

H72.11

Assume nonsuppurative H65.91

CASE: TYMPANOPLASTY

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Included


CASE: TYMPANOPLASTY

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Included

Approach

Included

CASE: TYMPANOPLASTY

12

Closure

No ossicular chain

reconstruction



CASE: TYMPANOPLASTY CASE

Diagnosis codes:

H90.11 Conductive hearing loss

H65.91 Chronic otitis media, right ear

H72.11 Attic perforation, right ear

CPT code:

69631 Tympanoplasty without OCR 13

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TYMPANOPLASTY WITH MASTOIDECTOMY

https://commons.wikimedia.org/wiki/Category:Middle_ear#/media/File:Blausen_0330_EarAnatomy_MiddleEar.png

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TYMPANOPLASTY WITH MASTOIDECTOMY CODES

Simple

CPT Code Description Comments 69641 Tympanoplasty with mastoidectomy

(including canalplasty, middle ear surgery, tympanic membrane repair); without ossicular chain reconstruction

• “Simple” mastoidectomy – not performed very often.

• The mastoid cortex is opened and the aditus ad antrum is identified 69642 with ossicular chain

reconstruction 15

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Canal Wall Up (CWU) CPT Code Description Comments

69643 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed wall, without ossicular chain reconstruction

• Removal of all, or almost all, the mastoid cells typically from the following areas: tegmen, presigmoid dural plate, sigmoid sinus and external auditory canal (posterior wall)

• The canal wall itself is maintained

69644 with intact or reconstructed canal wall, with ossicular chain reconstruction

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Canal Wall Down (CWD)

CPT Code Description Comments 69645 Tympanoplasty with mastoidectomy

(including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, without ossicular chain reconstruction

• The mastoid cells are removed from all the above mentioned areas, and

• Parts of the external auditory canal are removed (e.g., posterior wall and superior osseous part)

69646 radical or complete, with ossicular chain reconstruction

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FREQUENTLY USED GRAFT HARVEST CODES

Graft Harvest Codes CPT Code Description Comments

20926 Tissue grafts, other (e.g., paratenon, fat, dermis)

• Generic code for graft harvest/placement.

• Easier to pre-certify for diagnosis of chronic ear disease.

21235 Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft)

• Reconstructive code – includes graft harvest and placement.

• Controversy: appropriate for tragal cartilage graft to tympanic membrane?

• Difficult to pre-certify for chronic ear disease diagnosis. 18

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CASE: TYMPANOPLASTY WITH MASTOIDECTOMY

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69646 CWD M-Tplasty

From where? Is harvest billable?

Included: 69670 says “separate

procedure”

H71.02 Cholesteatoma of attic, left ear

H90.12 Conductive hearing loss, left ear


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Included for surgeon



21

Approach – fascia harvest included (same incision)

Use of endoscope

included

Another term for modified radical mastoidectomy which is similar

for CWD

Remove bones for hearing

Separate skin incision = 20926 vs 21235


22

Ossicular chain

reconstruction

Local graft



ICD-10-CM Codes: H71.02 Cholesteatoma of attic, left ear H90.12 Conductive hearing loss, unilateral (left ear)

CPT Codes: 69646 Tympanoplasty with mastoidectomy and OCR

(including canalplasty, middle ear surgery, tympanic membrane repair);

20926-51 Tissue grafts, other (e.g., paratenon, fat, dermis)

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NOSE


Source: http://commons.wikimedia.org/wiki/File:Illu09_sinuses.jpg#/media/File:Illu09_sinuses.jpg

Pituitary Gland Area

NOSE AND SINUS ANATOMY

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NOSE AND SINUS ANATOMY

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Source: https://upload.wikimedia.org/wikipedia/commons/2/2e/Blausen_0872_UpperRespiratorySystem.png


ENDOSCOPIC SINUS SURGERY

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Use 31254-31288 when an endoscope and instrumentation is used to remove bone and/or tissue. Use the balloon catheter dilation codes (31295-31297) when displacement occurs.

Removal of nasal polyps (e.g., 31237, 30115, 30117) is included in all endoscopic sinus surgery codes as part of the “approach” or “access.”

May separately report code(s) for septoplasty (30520) and inferior turbinate procedures when not performed for “access” or “approach”; be sure to document the medical necessity for these additional procedures.

ENDOSCOPIC SINUS SURGERY- MAXILLARY SINUS

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CPT Code Description 31256 Nasal/sinus endoscopy, surgical with maxillary

antrostomy; 31267 with removal of tissue from maxillary sinus

Removal of “tissue” (for 31267) means polyps, fungus ball, mucocele, etc.; not “debris” or “pus.” Removal must be from within the sinus (not at the ostium).

Codes include nasal polypectomy (e.g., 30115, 30117, 31237) on same side.

CPT 31267 includes 31256 on the same side.


ENDOSCOPIC SINUS SURGERY- ETHMOID SINUS

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CPT Code Description 31254 Nasal/sinus endoscopy, surgical; with

ethmoidectomy, partial (anterior) 31255 with ethmoidectomy, total (anterior and

posterior)

Includes nasal polypectomy (e.g., 30115, 30117, 31237) on same side.


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CPT Code Description

31287 Nasal/sinus endoscopy, surgical with sphenoidotomy; 31288 with removal of tissue from the sphenoid sinus

ENDOSCOPIC SINUS SURGERY- SPHENOID SINUS

Removal of “tissue” (for 31288) means polyps, fungus ball, mucocele, etc.; not “debris” or “pus”. Removal must be from within the sinus (not at the ostium).

Codes include nasal polypectomy (e.g., 30115, 30117, 31237) on same side.



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CPT Code Description 31276 Nasal/sinus endoscopy, surgical with frontal sinus

exploration, with or without removal of tissue from frontal sinus

Code includes nasal polypectomy (e.g., 30115, 30117, 31237) on same side.

Code requires frontal sinus exploration – be sure to document this in the body of the operative report.

Do not report 31276 for removal of disease from the frontal sinus recess; this is included in the total ethmoidectomy code (31255).

ENDOSCOPIC SINUS SURGERY - FRONTAL SINUS

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May report 31276 for the Draf I/IIA-B/III procedure where one can visualize the frontal sinus for exploration and proceed with removal of tissue from the frontal sinus (per AAO-HNSF).

• A Draf I frontal sinusotomy would include removing the posterior wall of the Agger nasi cells, the superior attachment of the bulla lamella of the ethmoid bulla, and/or Type I and II frontal cells. This removes tissue obstructing the frontal sinus

and is not part of the typical ethmoidectomy.

• A Draf IIA frontal sinusotomy would include removal of a Type III frontal cell reaching into the frontal sinus.

• A Draf IIB/III (endoscopic modified Lothrop) frontal sinusotomy not only reaches the ostium but enlarges it with punches, drills, etc.

• Be sure “Draf” is documented to support use of 31276.

ENDOSCOPIC SINUS SURGERY - FRONTAL SINUS


ENDOSCOPIC SINUS SURGERY- CONCHA BULLOSA RESECTION

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CPT Code Description

31240 Nasal/sinus endoscopy, surgical; with concha bullosa resection

May separately report when operative report documentation (e.g., diagnosis, indications, body of operative note) supports the procedure.

Includes nasal polypectomy (e.g., 30115, 30117, 31237) on same side.

CASE: ENDOSCOPIC SINUS SURGERY

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It is acute or chronic sinusitis? ICD-10-CM will require “acute”

vs. “acute recurrent” vs. “chronic”

All four sinuses = pansinusitis



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31276-50

31255-50

31288-50

Potential Codes

30140-50

30930 (but can’t bill with 30140)

Not billable

+61782

31267-50


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Helps to justify billing for navigation (+61782)

Support for 31267 and 31288

(“tissue removal”)



37

Preparation - not

billable

+61782


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Necessary for ESS codes

31256-LT

Polyps not inside sinus for 31267 so this is

31256



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31287-LT – no polyps removed

from inside sphenoid sinus

for 31288

31255-LT

Nasal polypectomy

included in ESS codes

31276-LT

Not separately billed.


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Now we have 31267-RT and

31267-LT

31288-RT and now we have 31288-LT also

31255-RT

31256-RT

31276-RT



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Not billable

30140-50 (30930

included)


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CPT CODES

Format A Format B

31276-50 Frontal sinuses 31276, 31276-50

31255-50 Ethmoid sinuses 31255-51, 31255-50

31267-50 Maxillary sinuses 31267-51, 31267-50

31288-50 Sphenoid sinuses 31288-51, 31288-50

30140-50 Inferior turbinate 30140-51, 30140-50

+61782 Navigation +61782


ENDOSCOPIC SINUS DILATION PROCEDURES

CPT Code Description Comments 31295 Nasal/sinus endoscopy,

surgical; with dilation of maxillary sinus ostium (e.g., balloon dilation), transnasal or via canine fossa

• Do not report with 31233, 31256 or 31267 for the same sinus.

31296 with dilation of frontal sinus ostium (e.g., balloon dilation)

• Do not report with 31276 for the same sinus.

31297 with dilation of sphenoid sinus ostium (e.g., balloon dilation)

• Do not report with 31235, 31287, or 31288 on the same sinus.

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CASE: ENDOSCOPIC SINUS DILATION

Operative note reads: Balloon sinus ostia catheterization and dilation of both maxillary sinuses under fluoroscopy. There is no documentation of removal of bone and/or mucosa.

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A B 31256

31256-50 31295

31295-50


INFERIOR TURBINATE SUBMUCOUS RESECTION CASE

What CPT code does this documentation support?

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INFERIOR TURBINATE SUBMUCOUS RESECTION CASE

A. 30140-50 B. 30140-LT C. 30140-RT D. Who knows which side!?

CPT 30140: Submucous resection inferior turbinate, partial or complete, any method

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THROAT/NECK

THROAT/NECK ANATOMY

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source: https://commons.wikimedia.org/wiki/Lung#/media/File:Respiratory_system_complete_en.svg


ANATOMIC STRUCTURES OF LARYNX

Glottis: The vocal apparatus of the larynx, consisting of the true vocal cords and the opening between them.

Subglottis: The most inferior part of the laryngeal cavity extending from glottis to the cavity of the trachea below.

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Source: https://commons.wikimedia.org/wiki/File:Blausen_0872_UpperRespiratorySystem.png

ANATOMIC STRUCTURES OF LARYNX

Vocal fold: A fold of mucous membrane covering the vocalis muscle in the larynx, forming the inferior boundary of the ventricle; also called true vocal cord.

False vocal fold: A fold of mucous membrane covering muscle in the larynx, separating the ventricle from the vestibule; also called false vocal cord.

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Source: https://commons.wikimedia.org/wiki/File:Blausen_0872_UpperRespiratorySystem.png


PROCEDURES - LARYNGOSCOPY Laryngoscopy: Includes exam of the tongue base, larynx, and hypopharynx.

Three types:

1. Direct - visualization with a rigid, hollow laryngoscope that would allow direct approach to the larynx, with microscope or telescope. A suspension procedure is performed with a direct laryngoscope suspended so as to leave both hands of the examiner free (a microscope or telescope is used).

2. Indirect - visualization indirectly via mirror or an angled rigid telescope for diagnosis or therapeutic procedures (typically performed in the office as part of an ENT exam).

3. Flexible - visualization through a flexible laryngoscope that uses fiber bundles or distal chip, with or without video.

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PROCEDURES - BRONCHOSCOPY

Bronchoscopy: Requires the bronchoscope go beyond the trachea and into the right or left bronchus. A rigid or flexible bronchoscope is inserted through the oropharynx, vocal cords and beyond the trachea into the right/left bronchi.

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Source: https://upload.wikimedia.org/wikipedia/commons/8/81/Diagram_showing_a_bronchoscopy_CRUK_053.svg


PROCEDURES

Esophagoscopy: requires exam from the cricopharyngeus muscle (upper esophageal sphincter-UES) to and including the gastroesophageal (GE) junction.

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Procedure

Direct Laryngoscopy

Microsuspension Laryngoscopy

Bronchoscopy

Rigid Esophagoscopy

Flexible Esophagoscopy

Diagnostic 31525 31526 31622 43191 43200 Biopsy(s) 31535 31536 31625 43193 42302 Dilation Initial

31528 Subsequent

31529

-

31630 43195 43196

43213 43214 43220 43226

Removal of Foreign Body(s)

31530 31536 31635 43194 43215

Excision of Tumor

31540 31541 31640 31641 (or relief

of stenosis)

-

43211 43216 43217

Injection(s) 31570 31571 - 43192 43201

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MOST COMMON OPERATIVE CPT CODES


CASE: AIRWAY

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Code not necessary since more definitive

diagnosis exist 31528 or 31529

Unknown whether this

surgery is initial dilation

(31528) or subsequent

(31529)

31571 31599

Larynx J38.6 Trachea J39.8

Nothing excised for 31541

Note: Surgeon does not mention bronchoscopy here – was one performed?

R06.1 Symptom not needed

CASE: AIRWAY

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31525 Diagnostic DL

Now 31525 becomes 31526

(MSL)


CASE: AIRWAY

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Now 31526 becomes 31528 DL for dilation initial OR it is

31529, subsequent

31571 Decadron injection

31599 Topical Mitomycin (or

not coded)

31622 Diagnostic bronchoscopy

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CPT Codes

1) 31571

31528-51

OR 31529-51

31622-51

31599

MSL with injection

Dilation, initial

Dilation, subsequent (possible modifier 22 for stenosis cuts)

Bronchoscopy

Unlisted code for topical Mitomycin, if coded (compare to 31571-52)

2)

3)

4)

CASE: AIRWAY


Neck Dissection CPT Codes Description 38700 Suprahyoid

lymphadenectomy Involves removal of level I nodes only

38720 Cervical lymphadenectomy (complete)

Complete or radical; includes all five regions of the neck. In addition, the internal jugular vein, the spinal accessory nerve, and the sternocleidomastoid muscle are removed.

38724 Cervical lymphadenectomy (modified radical neck dissection)

Modified radical or selective neck dissection (removal of lymph nodes in levels I – V); involves the removal of all lymph nodes routinely removed by radical neck dissection, while preserving the internal jugular vein, the spinal accessory nerve and/or the sternocleidomastoid muscle. Involves removal of more than level I nodes.

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NECK DISSECTION (LYMPHADENECTOMY) CODES

Do

31360 Laryngectomy without RND

38724-50, 59 Bilateral MRND

(or 38724-59 and 38724-50-59)

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Do not use a primary procedure code if it includes a radical neck dissection (RND) and you’ve done a modified radical neck dissection (MRND). Rather, report the primary code that does not include a neck dissection and separately report the modified radical neck dissection code(s).

Example: Laryngectomy with bilateral modified radical neck dissections

Don’t

31365 Laryngectomy with RND

38724-59 MRND

LARYNGECTOMY WITH AND WITHOUT NECK DISSECTION CODES


CASE: LARYNGECTOMY

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Diagnosis Codes

ICD-10-CM: C32.0

Sometimes modifier 22 is warranted for

added difficulty due to prior

radiation therapy.

43030

31360

31526 but included in laryngectomy 31622 Rigid or flexible? Included.

38724-50

No code - potential for modifier 22 on 31360 (but turns out partial

thyroidectomy done 60252) 31611

CASE: LARYNGECTOMY

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43200 Flexible esophagoscopy. Note

diagnoses of “reflux” and “Barrett’s esophagus” – this justifies performing

CPM (43030).

31526 (MSL) but included in

laryngectomy code

31622 Bronchoscopy but included


CASE: LARYNGECTOMY

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Anatomic locations evaluated are necessary for 43200. However, 43200

is included in 43030 (CPM) and laryngectomy.

CASE: LARYNGECTOMY

64

Left modified

radical neck

dissection (MRND) 38724


CASE: LARYNGECTOMY

65

Right MRND 38724

Thyroid exposure included in 31360 but removal for disease may be

billed.

Level 6 node dissection

included in 60252

CASE: LARYNGECTOMY

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43030 Cricopharyngeal myotomy coded because patient has indications.

31611 Tracheoesophageal

puncture

31360 Laryngectomy

w/o radial neck dissection

(RND)


CASE: LARYNGECTOMY

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Closure of wound edges

included in 31360; closure

by separate flap/graft obtained

through separate incision is billable.

Creation of stoma included

in 31360

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CPT Codes

31360

38724-50-59

60252-51

31611-51

43030-51

Laryngectomy without radical neck dissection (RND)

Bilateral modified radical neck dissections (MRND)

Subtotal thyroidectomy and central neck dissection

Tracheoesophageal (TE) puncture

Cricopharyngeal myotomy (CPM) [Use diagnosis codes of reflux and Barrett’s esophagus]

CASE: LARYNGECTOMY


FACIAL PLASTIC/ RECONSTRUCTIVE SURGERY

ADJACENT TISSUE TRANSFER OR REARRANGEMENT

70

Size Trunk

Scalp, Arms, and/or

Legs

Forehead, Cheeks, Chin, Mouth, Neck, Axillae, Genitalia, Hands and/or Feet

Eyelids, Nose, Ears

and/or Lips

10 sq cm or less 14000 14020 14040 14060

10.1 to 30.0 sq cm 14001 14021 14041 14061

30.1 to 60.0 sq cm 14301 each additional 30.0 sq cm or part thereof

+14302


ADJACENT TISSUE TRANSFER CODES

A. Rotation Flap

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B. Advancement

Flap

ADJACENT TISSUE TRANSFER CODES

Coders Tip: The following are some terms used by surgeons that qualify as use of an adjacent tissue transfer code:

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Z-plasty, W-plasty, V-Y plasty

Rotation flaps (assuming primary and secondary defects are documented)

Bilobed flaps

Advancement flaps (assuming primary and secondary defects are documented)

Rhomboid flaps

Double pedicle flaps


CASE: FACIAL PLASTIC/RECONSTRUCTIVE

Case 1 You excise two 2.1 cm squamous cell carcinomas: one from the nose and one from left cheek. Bilateral rotational advancement flaps are required for the nose, 8.0 sq cm.

Choose the correct code combination: ________

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A B 14060

14040-51 14060

14040-51 11643-51 11643-59

A

CASE: FACIAL PLASTIC/RECONSTRUCTIVE

Case 2 Excision of ear keloid scar with undermining to close the excision defect is an appropriate use of an adjacent tissue transfer code.

True_______ False_______

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X Teaching Points: 1. Use a complex repair code instead. 2. Code this case as a complex repair

(131xx) for scar revision


SKULL BASE SURGERY

EXCISION OF PITUITARY TUMOR

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Source: https://commons.wikimedia.org/wiki/File:1807_The_Posterior_Pituitary_Complex.jpg


NOSE AND PITUITARY GLAND ANATOMY

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Source: https://upload.wikimedia.org/wikipedia/commons/3/34/Illu_nose_nasal_cavities.jpg

Pituitary Gland Area

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Code Description Approach Involved 61548 Hypophysectomy or excision of pituitary

tumor, transnasal or transseptal approach, nonstereotactic

Through the nose but considered an open procedure (a microscope is used)

62165 Neuroendoscopy, intracranial; with excision of pituitary tumor, transnasal or trans-sphenoidal approach

Endoscopic (an endoscope is used)

Potential CPT Codes for Pituitary Tumor Removal

Above codes include the approach, resection/repair, and closure. Use modifier 62 (two surgeons) when ENT and NS perform the code together.



REMINDER: MODIFIER 62 (TWO SURGEONS)

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H&P Pre-op Period

Intraoperative Service

Post-op Period

Approach

Resection

Closure

90 days for both surgeons

62165


Comments

Codes include the approach, tumor removal and closure of operative tract.

May separately report 20926 (tissue graft) for harvest of abdominal fat graft via a separate skin incision.

May separately report code for stereotactic navigation (61781 or 61782) if the physician performed the set-up and registration of the system. Use 61781 if the stereotactic navigational system was used to resect an intradural tumor and use 61782 if the system was used to resect an extradural tumor.

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CO SURGEON Dr. Soleau

CASE: EXCISION OF PITUITARY TUMOR (ENT)

81

62165-62

+61781 (the pathology is intradural)

Dr. Neurosurgeon

Closure is included in 62165

D35.2, Benign pituitary tumor Diagnosis leads you to

2 codes: 61548 or 62165


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+61781

Not coding 20926

Access/ approach

not billable


NS

NS


83

31255 and 31287 for access included

in 62165

Co-surgeon, modifier 62. Intradural

procedure for 61781.

Access/approach (eg, septoplasty)

not billable


84

Closure included in 62165


Neurosurgeon

Otolaryngologist

CASE: EXCISION OF PITUITARY TUMOR (NS)

85

D35.2

62165-62

Diagnosis Code:

1) D35.2 Benign tumor, pituitary

CPT Codes:

CASE: EXCISION OF PITUITARY TUMOR

86

NS

62165-62 Dx: 1

ENT

62165-62 Dx: 1

+61781 Dx: 1


ENDOSCOPIC SKULL BASE SURGERY

87

Craniopharyngioma

Meningioma

Chordoma

Intracranial = Inside the skull (cranium)

Fossa = Shallow depression or hollow

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SKULL BASE ANATOMY


Anterior cranial fossa: A depression in the floor of the cranial base which houses the frontal lobes of the brain. It is formed by the part of the frontal, ethmoid, and sphenoid bones.

Middle cranial fossa: Deeper than the anterior cranial fossa and separated from the posterior fossa by the clivus and the petrous crest. It houses the temporal lobes of the brain and the pituitary gland.

Posterior cranial fossa: Located between the foramen magnum and tentorium cerebelli. It contains the brainstem and cerebellum.

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THERE ARE 3 SKULL BASE FOSSAE (PLURAL OF FOSSA):

SKULL BONE ANATOMY

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Source: https://commons.wikimedia.org/wiki/File:Human_skull_side_bones.svg#/media/File:Human_skull_side_simplified_(bones).svg


SKULL BASE ANATOMY

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Source: https://commons.wikimedia.org/wiki/File:Neurocranium_-_animation02.gif

Yellow: Frontal bone

Blue: Parietal bone

Purple: Sphenoid bone

Orange: Temporal bone

Green: Occipital bone

Red: Ethmoid bone

SKULL BASE ANATOMY

92

Source: https://commons.wikimedia.org/wiki/File:Neurocranium_-_inferior_view01.png

Yellow: Frontal bone

Blue: Parietal bone

Purple: Sphenoid bone

Orange: Temporal bone

Green: Occipital bone

Red: Ethmoid bone


ENDOSCOPIC SKULL BASE SURGERY

Endonasal/endoscopic procedures: Use an unlisted code (e.g., 64999) to report endoscopic/endonasal skull base surgery other than endoscopic resection of the pituitary (use 62165). It is not accurate to report open skull base surgery codes (61580-61616) for these endoscopic procedures.

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WWW.KARENZUPKO.COM

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WWW.KARENZUPKO.COM/RESOURCES/ARTICLES

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WWW.ENTNET.ORG - BULLETIN - KIM POLLOCK

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ACOUSTIC NEUROMA ANATOMY

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Source: https://upload.wikimedia.org/wikipedia/commons/9/90/Blausen_0009_AcousticNeuroma.png Source: https://upload.wikimedia.org/wikipedia/commons/7/7b/Blausen_0010_AcousticNeuroma_Tumor.png

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Code Description Approach Involved 61520 Craniectomy for excision of brain

tumor, infratentorial or posterior fossa; cerebellopontine angle

Retrosigmoid, Suboccipital

61526 Craniectomy, bone flap craniotomy, transtemporal (mastoid) for excision of cerebellopontine angle tumor;

Translabyrinthine, Transmastoid

Potential CPT Codes for Most Acoustic Neuroma Removal Procedures

Above codes include the approach, resection/repair, and closure. Use modifier 62 (two surgeons) when ENT and NS perform the code together.

EXCISION OF ACOUSTIC NEUROMA


REMINDER: MODIFIER 62 (TWO SURGEONS)

99

H&P Pre-op Period

Intraoperative Service

Post-op Period

Approach

Resection

Closure

90 days for both surgeons

61520 61526

CASE: EXCISION OF ACOUSTIC NEUROMA (ENT)

100

Documented retrosigmoid =

61520

Diagnosis leads you to 2 CPT codes:

61520 or 61526

D33.3, Benign neoplasm, acoustic nerve (cranial nerve)



101


102

Approach

No mention of microscope for +69990



103

Tumor resection

Closure

CASE: EXCISION OF ACOUSTIC NEUROMA (NS)

104

61520-62

aka Acoustic Neuroma

Included (not 20660)

Included (not 62140)

+69990


CASE: EXCISION OF ACOUSTIC NEUROMA

CPT Codes

May separately report codes for use of operating microscope (+69990), stereotactic navigation (+61781), placement of lumbar drain (62272), harvest of abdominal fat graft (20926).

105

Dr. ENT Dr. NS

61520-62 61520-62

https://www.pluralpublishing.com/publication_egc

o.htm

Discount code: AP2013

20% off

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Friday AM Advanced ICD-10 & Clinical Documentation Improvement for ENT

Friday PM Manage. Lead. Succeed.

Saturday Mastering ENT CPT Coding 2016

NOVEMBER 10-12 | CHICAGO, IL

For an online brochure and to register today go to:

www.karenzupko.com or 312-642-8310

10% Discount for Association of Otolaryngology Administrators (AOA) Members

Only a single workshop

remaining in 2016!

SIGN UP FOR

108

ALERTS


[email protected]

karenzupkoandassociates

@karenzupkoassoc

312.642.5616

www.karenzupko.com

karenzupko&associates Thank you

KIM POLLOCK RN, MBA, CPC, CMDP

2016 ADVANCED ENT SPECIALTY CODING SESSION c.ymcdn.com/sites/ · PDF file2016 ADVANCED ENT...

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