The ABCs of CPT Coding

CHICAGO-Important aspects of coding and reimbursement for otolaryngologists-head and neck surgeons-including some controversial coding issues-were covered in the American Rhinologic Society (ARS)’s Patient Advocacy Panel here at the 2006 Combined Otolaryngology Spring Meetings (COSM). The panel was moderated by Michael Setzen, MD, Clinical Associate Professor of Otolaryngology at New York University School of Medicine, Chief of the Rhinology Section at North Shore University Hospital at Manhasset (NY), and Chair of the ARS Patient Advocacy Committee. Dr. Setzen introduced the subject by saying, To receive appropriate reimbursement, one must document, show medical necessity, and use proper coding.

Dr. Setzen and two other speakers covered several important coding topics, and here are some highlights from their presentation.

Image Guidance System

The Current Procedural Terminology (CPT) code 61795 is used to reimburse for image guidance systems (IGS), including intracranial, extracranial, or spinal.

Clearly document when and why you used IGS, Dr. Setzen advised. Be specific about when you used it during surgery, and note it in detail in your operation report. If you get denied, send a copy of that report.

Dr. Setzen recommended adhering to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines for IGS, because the organization’s policy statement will support your actions. He added that AAO-HNS helped legitimize the use of IGS a year ago. The Academy presented four or five major changes in September 2005 to help us get better reimbursed, he said. These changes include the following statements in the guidelines:

1. IGS is not experimental or investigational.
2. There is sufficient expert consensus opinion and literature evidence to support its use.
3. It is impossible to corroborate this with level one evidence.
4. This technology is used at the discretion of the operating surgeon.
5. The intraoperative use of computer-aided surgery in appropriate select cases is endorsed to assist the surgeon in clarifying complex anatomy during sinus and skull base surgery.

When you are denied, this last statement is very helpful, said Dr. Setzen.

Endoscopic Sinus Debridement

The CPT code 31237 applies to debridement. FESS [functional endoscopic sinus surgery] has zero global days, thus you may begin to report endoscopic debridements the next day, said Dr. Setzen. Just be sure that you document this procedure similar to an operative report in your chart note! He added that you should report unilateral or bilateral codes as appropriate.

Don’t use this if you’re going to ‘clean out the nose’, advised Dr. Setzen. It must be a formal debridement to use this code. And if you’re telling the carrier that you’re using debridement over and above FESS, add on -79 to the 31237 code. Example: You may report debridements following septoplasty or turbinate surgery for FESS, as the debridement is performed for an unrelated diagnosis-use Modifier 79 (31237-79).