Thyroidectomy and Parathyroidectomy

Question:

Can we charge a thyroidectomy (e.g., 60240) when we do a parathyroidectomy (60500)

Answer:

Yes, but only if there is different pathology to support 60500.  The CPT Assistant from December 2012 states the following:

When a thyroidectomy is performed for malignancy, the parathyroid glands may also be removed, and because this would be considered incidental, the parathyroidectomy (60500) would not be separately reported. For example, if a left thyroidectomy was incidental to a left parathyroid biopsy and resection, then the work is considered inclusive of the parathyroid gland removal described by code 60500, as this code refers to all four parathyroid glands and is not reported as a unilateral procedure. Therefore, only code 60500 would be reported. However, if the thyroid lobectomy was performed for an independent diagnosis, then code 60220 would also be reported with modifier 59, Distinct Procedural Service, appended.

*This response is based on the best information available as of 10/31/19.

New FNA Codes and Diagnostic Ultrasound

Question:

I understand that the new FNA with ultrasound code, 10005, includes the ultrasound guidance for the FNA.  But, can we also charge 76536?

Answer:

Yes, if you have performed a separate diagnostic ultrasound to support 76536.  Remember, this is a radiology code. So if you are reporting 76536 without any modifiers (modifier 26-professional component or modifier TC for technical component) then you are billing for the diagnostic ultrasound interpretation like a radiologist would. Therefore, there must be a separate radiologic supervision and interpretation note for the diagnostic ultrasound.  This note would stay with the diagnostic study and be provided with the diagnostic study images if ever requested by the patient or someone else.

*This response is based on the best information available as of 09/05/19.

30140 (Submucous Resection) vs 30130 (Excision)

Question:

My work RVUs are down this year.  I do a lot of inferior turbinate submucous resection surgery and I code 30140 (Submucous resection inferior turbinate, partial or complete, any method).  I noticed that the wRVUs for 30140 are now 3.00 and last year they were 3.57.  This is a big hit for me.  I want to use 30130 instead because it has higher wRVUs.  What do I need to document?

Answer:

If the procedure you perform is 30140 then that is the code you should use.  The code with higher RVUs that you want to bill, 30130, is not the same as a submucous resection.  It describes a through-and-through “excision” (first word of the code descriptor) of all or part of the turbinate.  Based on the information you’ve provided, it seems you are accurately coding the procedure.  The issue you’ve identified is that the RVUs for 30140 went down in 2018 to account for the fact that 30140 is now a 0-day global period procedure; it was a 90-day postoperative global period procedure prior to 2018 thus the higher wRVUs.

*This response is based on the best information available as of 5/23/19.

Using G0268 for Cerumen Removal

Question:

When would I ever use G0268 for cerumen removal vs 69210?

Answer:

G0268 is a HCPCS II code for “Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing” while CPT code 69210 says “Removal impacted cerumen requiring instrumentation, unilateral.”  Historically, G0268 was used for the otolaryngologist’s work to remove impacted cerumen on the same patient as the audiologist performed diagnostic testing on the same day and all services were billed by the physician.  Using G0268 allowed payment for the procedure performed by a different provider because cerumen removal by an audiologist would be included in the diagnostic testing service.

Since 2008 when Medicare required audiologists to bill for their services separate from the physician, we’ve not had to use G0268 as often.  Most payors will separately credential audiologists (which we recommend doing, by the way) so they can bill separate from the physician; again, decreasing the need to use G0268.

So when would you use G0268?  When you, the physician, are submitting a claim for removal of impacted cerumen as well as the diagnostic testing performed by your audiologist on the same dayandthat payor “bundles” 69210 with the diagnostic testing.  You’d use G0268, instead of 69210, to show a different provider performed the cerumen impaction removal.

*This response is based on the best information available as of 5/9/19.

Fascia Lata Graft Denials

Question:

We routinely bill 69631 (tympanoplasty) and 20922 (temporalis fascia graft).  We’ve been paid but now we’re being asked to give money back.  Can you help?

Answer:

A thigh fascia lata graft was not harvested to support 20922.  Rather, if a temporalis fascia graft is harvested through a separate skin incision then you may separately report 20926 (tissue graft).  However, if the tympanoplasty is performed via post-auricular incision then 20926 is not separately reported for the temporalis fascia graft since it is considered a “local” graft.

*This response is based on the best information available as of 2/14/19.

Endoscopic Control of Epistaxis

Question:

We use coding software to help us with modifiers, procedure descriptions, RVUs etc. In the description for 31238 it mentions electrical cautery or laser but we use silver nitrate.  Is this code appropriate to use with use of silver nitrate only?

Answer:

The official AMA CPT instructions do not specify what tool or substance is used for control of epistaxis.  CPT 31238 merely states there is “control of nasal hemorrhage” endoscopically.  The most important aspect of this code is that the endoscope is held parallel to the instrument/tool/substance being used for epistaxis control.

*This response is based on the best information available as of 11/29/18.