Epistaxis Control

Question:

Can you explain when to use 30901 and 31231 rather than 31238? I’m confused.

Answer:

Sure! We discuss these codes in our national ENT coding workshop series (click here for future course dates/locations).  CPT 30901/30903 are used when you control epistaxis via means such as cautery but an endoscope is not used.  CPT 31238 is reported when the epistaxis is treated while you’re using an endoscope (ie, the scope and instrument to control epistaxis are parallel to each other in the nose).  CPT 31231 is a diagnostic code and may not be separately reported with either 30901/30903 or 31238 for services rendered at the same session due to the codes’ “separate procedure” designation by CPT.

*This response is based on the best information available as of 12/14/17.

92504 Binocular Microscopy

Question:

I used the microscope to examine both ears during an office visit because the middle ear Otoscopic exam was abnormal.  Can I report 92504 with modifier 50 (bilateral procedures)?

Answer:

No.  CPT 92504 describes using a microscope for an examination – it represents payment for using a separate piece of equipment for your exam.  The code is not reported twice, nor is modifier 50 appended, when both ears are examined.

*This response is based on the best information available as of 12/14/17.

Billing for Pre-Op H&P Visit

Question:

Hospitals require that we do an H&P within 30 days of taking a patient to the OR. If this visit is more than 48 hours prior to surgery, is that a billable visit?

Answer:

No, the H&P in this case is not a billable visit.  This question comes up often and was addressed by AMA CPT Assistant in the following excerpt:

“If the decision for surgery occurs the day of or before the major procedure and includes the preoperative evaluation and management (E/M) services, then this visit is separately reportable. Modifier 57, Decision for Surgery, is appended to the E/M code to indicate this is the decision-making service, not the history and physical (H&P) alone. If the surgeon sees the patient and makes a decision for surgery and then the patient returns for a visit where the intent of the visit is the preoperative H&P, and this service occurs in the interval between the decision-making visit and the day of surgery, regardless of when the visit occurs (1 day, 3 days or 2 weeks) the visit is not separately billable as it is included in the surgical package. Example: The surgeon sees the patient on March 1 and makes a decision for surgery. Surgery is scheduled for April 1. The patient returns to the office on March 27 for the H&P, consent signing, and to ask and clarify additional Question:s. The visit on March 27 is not billable, as it is the preoperative H&P visit and is included in the surgical package.”

Source: AMA CPT Assistant, May 2008/Volume 19, Issue 5, pp. 9, 11

CPT says once the decision is made to proceed with surgery the subsequent visits related to the procedure (e.g., doing H&P, getting consent form signed, answering Question:s) are included.  However, in some cases a patient may be a candidate for a surgical procedure but has a number of medical issues (such as cardiac disease and asthma) that require a medical evaluation to determine if he/she is healthy enough for surgery.  After the patient has had a “medical clearance” he/she returns to you to review the medical doctor’s evaluation and you at that point decide to proceed with surgery.  This visit can be billed as an E&M visit as the decision for surgery is just now being made.

*This response is based on the best information available as of 07/13/17.

Total Thyroidectomy and Reimplantation of Parathyroids

Question:

My doctor did a total thyroidectomy and reimplanted one of the parathyroid glands into the sternocleidomastoid muscle. Can I code 60512 in addition to 60240?

Answer:

CPT 60240 for the total thyroidectomy is correct. However, if one or more of the parathyroid glands is reimplanted in the same surgical exposure (e.g., SCM muscle) then it is not accurate to separately code +60512. The reimplantation should be done through a separate surgical approach/incision for +60512.

*This response is based on the best information available as of 05/25/17.

Septal Cartilage Graft and Septoplasty

Question:

My doctor did a septoplasty, CPT 30520, removed cartilage and fashioned it for a graft that he used in the surgical repair of vestibular stenosis, CPT 30465. Can we also code 20912 for the fashioning of the graft or just 30520 and 30465? I couldn’t find any CCI edits preventing this.

Answer:

Only one code, 30520 or 20912, may be reported as these procedures were performed through the same incision. What was the reason for the incision – to straighten the septum (30520) or to obtain the graft (20912)? Use whichever code is supported by the documentation but do not use both codes. .

*This response is based on the best information available as of 02/02/17.

Excisional Biopsy

Question:

My doctor’s documentation for a biopsy indicates he performed an “excisional biopsy of the skin”. Is this correct?

Answer:

No, CPT does not have a code for excisional biopsy. It is either a biopsy (11100 or 11101) or a benign or malignant excision code. (114xx, 116xx). It is important to use the appropriate terminology in the documentation to make it clear what type of procedure is performed. It is important to remember that all excision codes include a biopsy.

*This response is based on the best information available as of 01/19/17.