Coding Companion for ENT/ Allergy/Pulmonology

AENT.book Page 1 Tuesday, November 25, 2014 7:00 PM
Coding Companion for ENT/
Allergy/Pulmonology
A comprehensive illustrated guide to coding and reimbursement
2016
AENT.book Page i Tuesday, November 25, 2014 7:00 PM
Contents
Getting Started.....................................................................i
Skin/Integumentary .............................................................1
Repair ................................................................................23
Destruction........................................................................58
General Musculoskeletal ....................................................66
Head..................................................................................76
Neck/Thorax....................................................................161
Nose................................................................................166
Accessory Sinuses ............................................................199
Larynx .............................................................................230
Trachea/Bronchi...............................................................263
Lungs/Pleura....................................................................301
Arteries/Veins...................................................................317
Lymph Nodes ..................................................................327
Lips..................................................................................340
Vestibule of Mouth ..........................................................354
Tongue/Floor of Mouth ...................................................368
Dentoalveolar ..................................................................400
Palate/Uvula ....................................................................414
CPT © 2015 American Medical Association. All Rights Reserved.
Coding Companion for ENT/Allergy/Pulmonology
Salivary Gland .................................................................434
Pharnyx/Adenoids/Tonsils................................................455
Esophagus .......................................................................477
Stomach..........................................................................528
Thyroid............................................................................531
Parathyroid......................................................................542
Nervous...........................................................................546
Ocular .............................................................................554
External Ear .....................................................................558
Middle Ear .......................................................................574
Inner Ear..........................................................................623
Temporal Bone ................................................................631
Operating Microscope.....................................................635
HCPCS ............................................................................636
Appendix.........................................................................638
CCI..................................................................................704
Evaluation and Management ...........................................799
Index...............................................................................821
© 2015 Optum360, LLC
Contents
21555-21556 [21552,
21554]
21555 Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous;
less than 3 cm
21552
3 cm or greater
21556 Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg,
intramuscular); less than 5 cm
21554
5 cm or greater
ICD-9-CM Diagnostic
171.0
171.4
171.8
195.0
195.1
209.32
209.35
209.75
215.0
215.4
238.1
782.2
784.2
786.6
Malignant neoplasm of connective and other soft tissue of head,
face, and neck
Malignant neoplasm of connective and other soft tissue of thorax
Malignant neoplasm of other specified sites of connective and other
soft tissue
Malignant neoplasm of head, face, and neck
Malignant neoplasm of thorax
Merkel cell carcinoma of the scalp and neck
Merkel cell carcinoma of the trunk
Secondary Merkel cell carcinoma
Other benign neoplasm of connective and other soft tissue of head,
face, and neck
Other benign neoplasm of connective and other soft tissue of thorax
Neoplasm of uncertain behavior of connective and other soft tissue
Localized superficial swelling, mass, or lump
Swelling, mass, or lump in head and neck
Swelling, mass, or lump in chest
HCPCS Equivalent Codes
N/A
Medicare Edits
21552
21554
21555
21556
The physician removes a tumor from the soft tissue of the neck or anterior
thorax (chest) that is located in the subcutaneous tissue in 21552 or 21555
and in the deep soft tissue, below the fascial plane or within the muscle, in
21554 or 21556. With the proper anesthesia administered, the physician makes
an incision in the skin overlying the mass and dissects down to the tumor. The
extent of the tumor is identified and a dissection is undertaken all the way
around the tumor. A portion of neighboring soft tissue may also be removed
to ensure adequate removal of all tumor tissue. A drain may be inserted and
the incision is repaired with layers of sutures, staples, or Steri-strips. Report
21555 for excision of subcutaneous tumors whose resected area is less than
3 cm and 21552 for excision of subcutaneous tumors 3 cm or greater. Report
21556 for excision of subfascial or intramuscular tumors whose resected area
is less than 5 cm and 21554 for excision of subfascial or intramuscular tumors
5 cm or greater.
Non-Fac RVU
FUD
Status
MUE
12.79
21.01
8.8
15.19
12.79
21.01
11.87
15.19
90
90
90
90
A
A
A
A
3(1)
3(1)
Modifiers
21552
51
N/A
21554
51
N/A
21555
51
N/A
21556
51
N/A
* with documentation
N/A
N/A
N/A
N/A
Medicare Reference
80
80
N/A
N/A
None
Coding Tips
Codes 21552 and 21554 are resequenced codes and will not display in numeric
order. When any of these procedures are performed with another separately
identifiable procedure, the highest dollar value code is listed as the primary
procedure and subsequent procedures are appended with modifier 51. An
excisional biopsy is not reported separately when a therapeutic excision is
performed during the same surgical session. Report any free grafts or flaps
separately. For excision of cutaneous, benign lesions, see 11420–11426.
Surgical trays, A4550, are not separately reimbursed by Medicare; however,
other third-party payers may cover them. Check with the specific payer to
determine coverage.
CPT © 2015 American Medical Association. All Rights Reserved.
© 2015 Optum360, LLC
Coding Companion for ENT/Allergy/Pulmonology
Neck/Thorax — 163
Neck/Thorax
Explanation
Fac RVU
0208T-0209T
0208T Pure tone audiometry (threshold), automated; air only
0209T
air and bone
Explanation
Pure tone audiometry is performed using a computer-assisted audiometer. Many
causes of hearing loss have characteristic threshold curves. In pure tone
audiometry, earphones are placed and the patient is asked to respond to tones
of different pitches (frequencies) and intensities. The threshold, which is the
lowest intensity of tone the patient can hear 50 percent of the time, is recorded
for a number of frequencies on each ear. For pure tone signals, which are
single-frequency tones produced electronically and transferred through an
earphone or bone conduction vibrator, hearing sensitivity is measured separately
in each ear. In one method, noise is masked to the non-test ear when it is
determined by the computer that masking is necessary. Through touch-screen
operation, the patient self-administers the tests while following verbal and
on-screen instructions. Report 0208T for automated audiometry including the
air conduction mode only and 0209T for automated audiometry including air
and bone conduction modes. The air and bone thresholds are compared to
differentiate between conductive, sensorineural, or mixed hearing losses.
0210T-0211T
0210T Speech audiometry threshold, automated;
0211T
with speech recognition
Appendix
Explanation
Automated speech audiometry thresholds are performed using a
computer-assisted device. Causes of hearing loss can often be diagnosed through
tests using an audiometer. Many causes of hearing loss have characteristic
threshold curves unique to that specific diagnosis. In speech audiometry,
earphones are placed and the patient is asked to repeat bisyllabic (spondee)
words. The softest level at which the patient can correctly repeat 50 percent of
the spondee words is called the speech reception threshold. The threshold is
recorded for each ear in 0210T. This process occurs in 0211T, in addition to a
discrimination test. The word discrimination score is the percentage of spondee
words a patient can repeat correctly at a given intensity level above his or her
speech reception threshold. This is also measured for each ear.
0212T
0212T Comprehensive audiometry threshold evaluation and speech
recognition (0209T, 0211T combined), automated
Explanation
Automated comprehensive audiometry threshold evaluation and speech
recognition is performed with the use of a computer-assisted device. Causes of
hearing loss can often be diagnosed through tests using an audiometer. Many
causes of hearing loss have characteristic threshold curves. In comprehensive
audiometry, earphones are placed and the patient is asked to respond to tones
of different pitches (frequencies) and intensities. The threshold, which is the
lowest intensity of tone the patient can hear 50 percent of the time, is recorded
for a number of frequencies on each ear. Bone thresholds are obtained in a
similar manner except a bone oscillator is used on the mastoid or forehead to
conduct the sound instead of tones through earphones. The air and bone
thresholds are compared to differentiate between conductive, sensorineural, or
mixed hearing losses. With the earphones in place, the patient is also asked to
repeat bisyllabic (spondee) words. The softest level at which the patient can
correctly repeat 50 percent of the spondee words is called the speech reception
threshold. The threshold is recorded for each ear. The word discrimination score
is the percentage of spondee words that a patient can repeat correctly at a given
intensity level above his or her speech reception threshold. This is also measured
for each ear.
0232T
0232T Injection(s), platelet rich plasma, any site, including image guidance,
harvesting and preparation when performed
Explanation
The physician injects platelet rich plasma (PRP) into a targeted site. Harvesting
and preparation may also be performed using a variety of techniques. In one,
venous blood is drawn from the region of the arm in front of the elbow
(antecubital vein) using a butterfly needle. The blood is placed into an
appropriate container, centrifuged, and separated into platelet poor plasma
(PPP), RBC, and PRP. The PPP is extracted and discarded and the PRP is
withdrawn for use. The injection site is marked in order to localize the PRP
injection; image guidance may be used. Under sterile conditions, the physician
injects the PRP directly into the target area, sometimes using lidocaine or
Marcaine. If administered to a joint space, calcium chloride and thrombin may
also be added in order to provide a gel matrix for the PRP to adhere to. PRP has
many indications, including wound care for the treatment of diabetic and venous
stasis ulcers, chronic nonhealing tendon injuries, plantar fasciitis, and
augmentation and fusion of bone. Studies suggest that PRP can aid in wound
and soft tissue healing and can affect narcotic requirements, bone production
(osteogenesis), postoperative blood loss, and inflammation.
0240T-0241T
0240T Esophageal motility (manometric study of the esophagus and/or
gastroesophageal junction) study with interpretation and report; with
high resolution esophageal pressure topography
0241T
with stimulation or perfusion during high resolution esophageal
pressure topography study (eg, stimulant, acid or alkali perfusion)
(List separately in addition to code for primary procedure)
Explanation
The physician inserts a tube with sensors (approximately 1 cm apart) into the
patient's nose or mouth and down into the stomach to perform an esophageal
motility study. In high resolution esophageal pressure topography, the data is
collected and displays a representation of the pressure pattern and pressure
dynamics throughout the entire esophagus, obtaining information regarding
anatomy and pressure gradients, along with the contractile activity. In 0240T,
the muscles of the esophagus and/or the gastroesophageal junction, which
propel food and water into the stomach, are studied to measure the pressure
of the contraction waves and diagnose abnormalities in the esophageal muscle
that affect swallowing. The tube is slowly withdrawn and stopped at different
points along the esophagus. The patient is directed to swallow a little amount
of water at each stopping point and the contraction wave pressure and
swallowing action are measured and graphed. Report 0241T in addition to the
motility study code when the motility study is combined with stimulation and/or
acid or alkali perfusion. The mecholyl provocation test determines the severity
of bronchial hypersensitivity, as well as the cause and effectiveness of treatment
for bronchospasm. Varied doses of methacholine chloride solution are
administered to the patient, following a scheduled protocol of gradually
increasing concentration. The patient performs breathing as instructed, and test
measurements are taken by spirometry, both before and three minutes after
the inhalation challenge of gradually increasing, aerosolized methacholine
chloride/diluent solution. A provocative acid perfusion study, also called a
Bernstein test, may be administered to attempt to replicate the type of chest
pain the patient has been experiencing. This aids in diagnosing the pain as
non-cardiac, due to esophageal reflux. Both hydrochloric acid and an alternate
saline control solution are infused one after the other via the nasogastric tube,
without the patient being aware of the identity of the solution. The symptoms
of chest pain are recorded as the patient identifies them.
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638 — Appendix
Coding Companion for ENT/Allergy/Pulmonology
AENT.book Page 799 Tuesday, November 25, 2014 7:00 PM
Evaluation and Management
Evaluation and Management
Types of E/M Services
Providers
Coding Companion for ENT/Allergy/Pulmonology
Evaluation and Management — 799