Post-Tonsillectomy Bleed

Question:

I am being told that treating a post-tonsillectomy bleed in the ED with local anesthesia and silver nitrate will not be paid.  Is it true that the only code that would be reimbursed is bringing the patient back to the OR?

Answer:

Medicare says that the tonsillectomy’s 90-day postoperative period includes treatment of any complications (e.g., bleed) unless the patient is taken to the operating room.  So if this is a patient covered by Medicare, or Medicare payor, then the ED service would not be billed.  You’ll have to check your non-Medicare plans to determine their postoperative global period policy and whether services provided in the ED related to the surgical procedure are separately payable.

*This response is based on the best information available as of 09/06/18.

Removal of Tympanostomy Tube

Question:

What is the code for removal of a tympanostomy tube when it was placed by another physician?  I can’t seem to find it in the CPT book anymore.

Answer:

Oh my goodness – that code describe was revised in 2003!  CPT 69424 now states: Ventilating tube removal requiring general anesthesia.  If the tube is removed under local, or no, anesthesia then it is included in your E/M service and not separately coded.

Please come quickly to an upcoming KZA coding course!Here are the dates and locations.

*This response is based on the best information available as of 03/15/18.

Denials of 30930 with 30140

Question:

We are getting denials when billing 30930 (outfracture of inferior turbinates) with 30140 (submucous resection of inferior turbinate). Do you know how we can get paid?

Answer:

Actually, it is not accurate to use both codes together for procedures on the same turbinate. CPT guidelines clearly state that 30930 (and 30801, 30802) are included in 30140 and should not be separately coded.  So, no, we cannot help you get paid but we can help you stay out of trouble by advising you not to report 30930 with 30140.

*This response is based on the best information available as of 03/01/18.

Debridement of the External Auditory Canal

Question:

I can’t find a CPT code for debridement of the EAC such as for Swimmer’s ear. Help!

Answer:

Actually there isn’t one! Typically the debridement is performed with a microscope so you may report 92504 (binocular microscopy) with your E/M code assuming your documentation supports it. Do not use a code such as 11000 (Debridement of extensive eczematous or infected skin; up to 10% of body surface) as the intent of this code is not for use in the ear canal.

*This response is based on the best information available as of 02/15/18.

New Endoscopic Sinus Surgery Codes

Question:

I heard there are new endoscopic sinus surgery codes. What’s the scoop?

Answer:

Yes!  There are a couple new codes this year that bundle an endoscopic total ethmoidectomy with a:

• frontal sinusotomy – new code 31253
• sphenoidotomy without tissue removal – new code 31257
• sphenoidotomy with tissue removal – new code 31259.

Use one of the bundled codes first before using a code(s) for other sinuses addressed (maxillary, sphenoid, anterior ethmoidectomy).

*This response is based on the best information available as of 01/18/18.

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.