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New Versus Established in the Office
We have one Facial Plastic surgeon in our practice with five otolaryngologists. We have a patient who sees our facial plastic surgeon sees a patient for the first time. The patient is established to our practice and has been seen in the past three years. Is the patient considered “new” the first time the Facial Plastic surgeon sees the patient?
Question:
We are an otolaryngology practice, and we added a facial plastic surgeon to our group. If he sees one of our established patients for the first time in the office, would that be a new or established patient for the plastic surgeon? He does not share the same taxonomy or specialty code with our Otolaryngologists and is credentialed as specialty code 24.
Answer:
This is a great question. Since the Facial Plastic surgeon is credentialed as specialty 24 and Otolaryngology is credentialed as specialty 04, the patient would be considered a new patient for the plastic surgeon. Understanding the coding rules for new versus established patients in the office or outpatient setting is important.
A new patient has not received any professional services from the physician or other qualified health care professional or another physician or other qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice within the past three years.
An established patient has received professional services from the physician or other qualified health care professional or another physician or other qualified health care professional of the same specialty and subspecialty who belongs to the same group practice within the past three years.
*This response is based on the best information available as of 10/17/24.
Neck Dissection
My physician did a total thyroidectomy with a modified radical neck dissection. Can I report the radical neck dissection with the thyroidectomy?
Question:
My physician did a total thyroidectomy with a modified radical neck dissection. Can I report the radical neck dissection with the thyroidectomy?
Answer:
If your physician performed the total thyroidectomy using CPT code 60240 and modified radical neck dissection (38724), both procedures may be reported during the same operative session. The first listed code on the claim should be CPT 38724. Modifier 59 should be appended to CPT code 60240 (lower RVU) since it is bundled under the National Correct Coding Initiative.
*This response is based on the best information available as of 9/5/24.
Microtia Surgery
What CPT code is appropriate for creating a cutaneous pocket fashioned for the framework for stage 1 of a microtia surgery?
Question:
What CPT code is appropriate for creating a cutaneous pocket fashioned for the framework for stage 1 of a microtia surgery?
Answer:
The appropriate code for creating a cutaneous pocket in the context of stage 1 microtia surgery is CPT 14061 (adjacent tissue transfer). This code corresponds to the procedure involving creating a cutaneous pocket in the right ear and transferring. The cutaneous pocket is essential for accommodating the framework created during reconstruction. Since the code is selected based on anatomic location and sq centimeter size be sure to document this information in the operative report.
*This response is based on the best information available as of 7/11/24.
Cancer Surveillance
When a patient comes in for head and neck cancer surveillance with severe xerostomia because of radiation therapy, and the physician does a complete workup for the xerostomia, and there is detailed documentation about the xerostomia, can we bill an E/M service along with the flexible laryngoscopy (31575)?
Question:
When a patient comes in for head and neck cancer surveillance with severe xerostomia because of radiation therapy, and the physician does a complete workup for the xerostomia, and there is detailed documentation about the xerostomia, can we bill an E/M service along with the flexible laryngoscopy (31575)?
Answer:
If the patient is seen for follow-up for head and neck cancer and they are also being treated for xerostomia you would be able to report a separate E/M service as long as the workup for the xerostomia is documented and treated or there is a change in plan of care to support the evaluation and management service.
*This response is based on the best information available as of 6/20/24.
Cryoablation
I was told we still need to use the unlisted code 30999 for cryoablation of the nasal nerve.
Question:
I was told we still need to use the unlisted code 30999 for cryoablation of the nasal nerve.
Answer:
You no longer report cryoablation of the nasal nerve with an unlisted code. In 2024, a new code was created to report Nasal cryotherapy (31243), also known as nasal cryoablation or cold therapy, as a noninvasive treatment to stop symptoms of chronic rhinitis.
*This response is based on the best information available as of 6/6/24.
Suctioning Debris from the Ear Canal
I just suctioned debris from the ear canal as there was no impacted cerumen. Can I still use 69210?
Question:
I just suctioned debris from the ear canal as there was no impacted cerumen. Can I still use 69210?
Answer:
No. CPT 69210 is specifically for removing impacted cerumen. There is no CPT code for suctioning an ear canal of debris (e.g., Swimmer’s ear, otitis externa). You would report an E/M code and you could also report 92504 if you used the microscope to suction the ear canal.
*This response is based on the best information available as of 5/23/24.