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Coding Both Dix-Hallpike and the Epley Maneuver
I billed 95992 (Epley) and 92532 for the Dix-Hallpike I did. I got paid for 95992 but not 92532. Should I have used a modifier to get paid and should we appeal the denial?
Question:
I billed 95992 (Epley) and 92532 for the Dix-Hallpike I did. I got paid for 95992 but not 92532. Should I have used a modifier to get paid and should we appeal the denial?
Answer:
No. CPT 92532 is for positional nystagmus testing without a recording such as what you did for a Dix-Hallpike maneuver. CPT allows coding both 95992 and 92532 together. That said, Medicare, and most payors, consider this service included in the E/M or other service (95992) code you reported and not separately payable. .
We consider the performing the Dix-Hallpike, without a permanent recording, to be part of the exam performed and not separately billable. We do not recommend appealing the denial.
*This response is based on the best information available as of 02/20/20.
Ear Exam Under Anesthesia
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…
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
Is it ok to code 69641, 69642, and 69643 for procedures performed on the same ear at the same operative session?
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
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.
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
Can we charge a thyroidectomy (e.g., 60240) when we do a parathyroidectomy (60500)
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
I understand that the new FNA with ultrasound code, 10005, includes the ultrasound guidance for the FNA. But, can we also charge 76536?
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.