Diagnosis Code for Laryngopharyngeal Reflux

Question:

I’m getting used to ICD-10-CM! Thanks so much for teaching me about it. I do have a question though. I can’t seem to find a diagnosis code for laryngopharyngeal reflux. What do you suggest?

Answer:

Actually, we’ve always suggested using K21.9, Gastro-esophageal reflux disease without esophagitis. Coincidentally, in a recent issue (first quarter 2016) of the American Hospital Association’sThe Coding Clinic, the same advice was provided.

*This response is based on the best information available as of 09/15/16.

Tympanostomy Tube with Intratympanic Injection

Question:

I did an intratympanic steroid injection and coded 69801 and 69433. Medicare paid 69801. Should I appeal the denial of 69433?

Answer:

No! CPT 69801 says Labyrinthotomy, with perfusion of vestibuloactive drug(s); transcanal. The CPT guidelines say: Do not report 69801 in conjunction with 69420, 69421, 69433, 69436 when performed on the same ear. By billing 69801 and 69433, for procedures on the same ear, you’ve unbundled the codes. The denial is accurate so you should not appeal. Furthermore, in the future, do not bill 69433 or 69436 (tympanostomy tube placement) or 69420 or 69421 (myringotomy) for the same ear when you also report 69801.

*This response is based on the best information available as of 04/28/16.

Repair of Nasal Vestibular Stenosis

Question:

I am trying to come up with the right CPT codes for a repair of nasal vestibular stenosis so we can get it pre-certified. Can you help?

Answer:

Yes, you are wise to determine the correct codes for pre-certification, otherwise the surgery might not be paid if you billed different codes.  Look at 30465 – Repair of nasal vestibular stenosis (e.g., spreader grafting, lateral nasal wall reconstruction).  You may also report a separate code if you harvest graft material through a separate incision.  For example, you may report 20912 (Cartilage graft; nasal septum) if you harvest septal cartilage graft when you have not performed a septoplasty at the same operative session.  If you did a septoplasty (30520) and repair of nasal vestibular stenosis (30465) then you may not report 20912 for the septal cartilage graft harvested/obtained from the septoplasty.

*This response is based on the best information available as of 01/14/16.

Endoscopic Skull Base Surgery

Question:

We are thinking about starting an endoscopic skull base surgery program and doing skull base procedures via an expanded endonasal/endoscopic approach. I’ve looked in the CPT book for codes and it looks like CPT 61580-61619 are just what I’m looking for. Is this correct?

Answer:

That’s great that you’re starting a new program! And, we can help. There is one CPT code for an endoscopic skull base procedure – 62165, Neuroendoscopy, intracranial; with excision of pituitary tumor, transnasal or trans-sphenoidal approach. However, other procedures that you’ll do such as an endoscopic resection of a clival chordoma are not accurately coded using 61580-61619, as these existing codes are for open procedures. We wrote an article for the AAO-HNS Bulletin about this a few years ago that I think you’ll find helpful. Here are the links:

Sample Prior Authorization, Cover Letter, or Appeal Letter for the Otolaryngologist’s Use of an Unlisted CPT Code for Endoscopic/Endonasal Skull Base Surgery

Coding and Reimbursement Strategies: Using an Unlisted Code for Endoscopic Skull Base Surgery

*This response is based on the best information available as of 12/03/15.

Lipoma Removal

Question:

I removed a huge lipoma from a patient and it seems like the benign skin lesion removal codes just don’t describe what I’m doing. Is there another code I can use?

Answer:

Yes! The “soft tissue tumor” codes were introduced into CPT in 2010 and better describe the procedure you are performing. These codes are located in the Musculoskeletal System section of CPT (e.g., 21555, 21556) rather than in the Integumentary System section of CPT (114xx for excision of benign skin lesions, 116xx for excision of malignant skin lesions).

*This response is based on the best information available as of 07/30/15.

Paramedian Forehead Flap After Mohs Surgery

Question:

I did a paramedian forehead flap after the Mohs surgeon removed the cancerous lesion from the nose. What is the CPT code for this procedure and do I need a modifier because I’m in the Mohs surgeon’s global period?

Answer:

The code is 15731 (Forehead flap with preservation of vascular pedicle (e.g., axial pattern flap, paramedian forehead flap)). You should not need a modifier because you are a different specialty (Otolaryngology) from the Mohs surgeon (Dermatology) and payers should not consider you to be in the Mohs surgeon’s global period.

*This response is based on the best information available as of 05/21/15.