Intraoperative Laryngeal Nerve Monitoring with Thyroidectomy Procedures

Question:

Are we able to bill for laryngeal nerve monitoring with thyroidectomy procedure?

Answer:

No – CPT is very clear in that intraoperative monitoring (e.g., 95940, 95941) is included in the global surgical package for the surgeon and should not be separately reported.

*This response is based on the best information available as of 06/11/20.

Nasal Endoscopy and Epistaxis Control

Question:

Can we charge a 31231 and a 30901, 30903, or 30905 if the scope is withdrawn and then the cautery is done?

Answer:

No.  CPT 31231 is a diagnostic procedure and includes the parenthetical statement “separate procedure.”  That means 31231 is included in a more definitive therapeutic/treatment procedure at the same operative session.  Report either CPT code 31231 or 30901 (or 30903 or 30905), but not both codes.

*This response is based on the best information available as of 05/28/20.

Coding Both Dix-Hallpike and the Epley Maneuver

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

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.