Coding and Documenting Advice from the Experts

Otolaryngologists can also bill a 99214 based on time, not on the history and physical exam and MDM, if they spend at least 25 minutes with a patient and more than 50% of their time involves counseling or coordination of the patient’s care. Documentation must include the total time spent for the encounter and the amount of time spent discussing the patient’s care, as well as what was discussed.

Knowing how to code E&M appropriately will be critical to ensuring that you receive the reimbursements you are entitled to, especially should Medicare decide to decrease reimbursements, said Dr. Setzen.

Consultation

Understanding what constitutes a consult is also important, added Ms. Cobuzzi. Although there have traditionally been just ‘three Rs’ that we talk about regarding a consult-‘request,’ ‘render,’ and ‘respond’-I’ve added two more: ‘reason’ and ‘return.’

In January 2006, the Centers for Medicare and Medicaid Services changed the rules indicating that there had to be a reason for doing a consultation, continued Ms. Cobuzzi. This simply means that you need to include the reason why the patient was referred to you as part of the request. Be sure to write this in your chart and send some type of response letter to the requesting physician for his or her chart that also indicates that you are proceeding with treatment unless you hear otherwise.

I think of the ‘return’ part of the consultation like Netflix-you borrow the DVD, view it, send it back, but do not buy it. Similarly, once you’ve rendered care to the patient, you need to return the patient ‘on loan’ to the requesting physician and by doing so, you are showing that that episode of care is finished and you are now ready to move on.

Coding in otolaryngology will continue to evolve as newer technologies and procedures emerge. Meanwhile, there are sometimes no easy answers as to what are the correct CPT codes to use, summarized Dr. Rosen. To negotiate for fast, clean preapproval and payment, meet with the insurance provider(s), present the facts, and demonstrate the cost savings. Or write a cover letter explaining these items and attach it with your claim submission.

Otolaryngology Exam (’97)

Includes:

• Examination of oropharynx: oral mucosa, hard and soft palates, tongue, tonsils and posterior pharynx (e.g., asymmetry, lesions, hydration of mucosal surfaces)
• Inspection of pharyngeal walls and pyriform sinuses (e.g., pooling of saliva, asymmetry, lesions)
• Examination by mirror of larynx including the condition of the epiglottis, false vocal cords, true vocal cords, and mobility of larynx (use of mirror not required in children)
• Examination by mirror of nasopharynx including appearance of the mucosa, adenoids, posterior choanae, and eustachian tubes (use of mirror not required in children)

Source: www.aapc.com/education/elearning.aspx