Jessica Edmiston, CPC, Senior Vice President, Coding at National Medical Billing Services, shares two common mistakes in coding ENT procedures and discusses how they can be corrected.
1. Not reporting tympanoplasty graft harvested from a separate incision as a separate procedure code.
As of Aug. 2008, the AMA now allows the harvesting of graft through a separate incision to be reported in addition to the tympanoplasty code. Before Aug. 2008, the AMA did not allow for grafts to be billed separately, says Ms. Edmiston. Failing to bill the harvesting of the graft separately would result in a loss of reimbursement for the ASC.
If a physician uses a separate incision for a graft during tympanoplasty, the coder should bill for the tympanoplasty (CPT 69631) code and for the corresponding graft code, such as a tissue graft (CPT 20926) or a cartilage graft (CPT 21235).
2. Miscoding frenulum incisions as excisions, excisions as incision.
Another common mistake in ENT coding is confusing frenotomy (CPT 41010), which is the incision of the frenulum, with a frenectomy (CPT 41115), which is the excision of the frenulum. Ms. Edmiston warns that sometimes physicians will mislabel the procedure on their procedure heading, so it is important to read the operative note careful to ensure accurate coding.
The information provided should be utilized for educational purposes only. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
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Ref. Becker’s Healthcare
This post was first published December 7, 2009 and was updated July 29, 2020.