Otolaryngology Coding Alert
Pay Attention to Diverticulectomy Approach
Question: What CPT code should I report for an endoscopic cricopharyngeal myotomy using the Weerda Zenker diverticuloscope?
Ohio Subscriber
Answer: Coding an endoscopic cricopharyngeal myotomy can prove tricky. At first glance, you may assume the correct code is 43130 (Diverticulectomy of hypopharynx or esophagus, with or without myotomy; cervical approach).
Problem: Code 43130 describes an open surgery. Because the otolaryngologist in your example uses an endoscopic, rather than a cervical approach, you should instead use unlisted procedure code 43499 (Unlisted procedure, esophagus).
Best practice: You should also write a letter to the CPT AMA Committee (address in front of CPT book) and the Practice Management Board of the Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). Explain to the members that the otolaryngologist is performing cricopharyngeal myotomy endoscopically.
You should take this extra step every time that a surgeon performs a CPT defined open surgery endoscopically. Alerting the proper agencies that surgeons are now performing the open surgery endoscopically helps the boards eventually obtain CPT codes to describe the endoscopic surgery.
Otolaryngology Coding Alert
- Simplify Tracheostomy Tube Replacement Coding With One of These Choices
"Strategy: Try 31899 for OR change under general anesthesia
Even though no code describes a postfistula [...] - Skipping This Step Could Result in FESS, Audiogram Mispayment
Verify modifier -50 use with fee schedule
Before you append modifier -50 to an ENT procedure, [...] - You Be the Coder:
Consider Debridement's Relation to Flap Repair
Question: An otolaryngologist repairs a gunshot victim's facial and lip wounds. We are using 40527 [...] - You're Responsible for Modifier -50 Reimbursement
Not doubling 31267 fee could cost you $175 plus
You can avoid shorting yourself maxillary antrostomy [...] - READER QUESTIONS:
Pay Attention to Diverticulectomy Approach
Question: What CPT code should I report for an endoscopic cricopharyngeal myotomy using the Weerda [...] - READER QUESTIONS:
Place Modifier -59 on Bundled Code
Question: How do I determine which code to append modifier -59 to?
New Jersey Subscriber
Answer: [...] - READER QUESTIONS:
Group Specialist Service Doesn't Establish Patient
Question: Is a patient a new or an established patient when a physician in one [...] - READER QUESTIONS:
Code Definitive Dx, Not R/Os
Question: May I use 'rule out' (R/O) as the reporting diagnosis?
Ohio Subscriber
Answer: You should [...] - READER QUESTIONS:
Office Codes Usually Pay More Than Facility
Question: What is the difference between facility and non-facility relative value units (RVUs)?
Kansas Subscriber
Answer: CMS [...]
