Ear Exam Under Anesthesia

Question:

Our surgeon performed an evaluation of the external ear canal on a pediatric patient, under general anesthesia, because the child would not allow the surgeon to evaluate the ears thoroughly in the office. We cannot find a CPT code for this service. Do we use an unlisted code?

Answer:

CPT code 92502, (Otolaryngologic examination under general anesthesia) describes a complete ENT exam under general anesthesia. If only the ears were examined, then modifier 52 (reduced services) would be appended to indicate an entire otolaryngologic examination was not performed.

*This response is based on the best information available as of 01/23/20

Mastoidectomy Code Question

Question:

Is it ok to code 69641, 69642, and 69643 for procedures performed on the same ear at the same operative session?

Answer:

Absolutely not.  Use only one CPT code – whichever represents the procedure performed.

*This response is based on the best information available as of 12/05/19.

Binocular Microscopy

Question:

I oftentimes bill and E/M code with modifier 25 for an office visit and 92504-50 (1 unit) for the binocular microscopy to Medicare.  I get denied on 92504-50 but I am paid on 99212. The denial code is “CO-4 The procedure code is inconsistent with the modifier used or a required modifier is missing” and “M20 Missing/incomplete/invalid HCPCS” or “N519 Invalid combination of HCPCS modifiers.”  Then Medicare says no appeal rights are afforded because the claim is unprocessable and I should submit a new claim with the complete/correct information. I don’t understand what’s wrong.  Please help.

Answer:

What’s wrong is that modifier 50, for bilateral procedures, should not be appended to 92504. CPT 92504 is reported only once without modifier 50.  Additionally, you probably don’t need modifier 25 on the E/M code to Medicare because there is not a National Correct Coding Initiative (NCCI) edit between the two codes which would warrant modifier 25.

*This response is based on the best information available as of 11/14/19.

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.