How to Solve 3 Otolaryngology Coding Scenarios

Posted on 21 Jun, 2019 |comments_icon 0|By Elizabeth

Stop revenue loss with expert guidance to keep your otolaryngology claims in tiptop shape.

If otolaryngology coding confusion has you concerned about reimbursement loss, this post is for you. Join Brett Rosenberg, MA, CPC, CCS-P, COC, editor-in-chief of TCI’s Otolaryngology Coding Alert, and Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO, AAPC Fellow, as they deliver expert guidance to arrest potential coding errors before they siphon off your hard-earned pay.

Scenario 1: Note Cat. III Codes with Placement of Hypoglossal Nerve Stimulator

What’s the CPT® code for the placement of a hypoglossal nerve stimulator? I can’t seem to find a code that includes both the placement of the stimulator and the chest wall respiratory sensor electrode.

Answer: Prior to 2017, you’d have to report code 64999 (Unlisted procedure, nervous system) when the provider performed the placement of both the stimulator and chest wall respiratory sensor electrode. If the provider only performed the placement of the hypoglossal nerve stimulator, you would report code 64568 (Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator).

As of 2017, CPT® introduced the following three Category III codes that you will use to report the physician’s placement of the chest wall respiratory sensor electrode:

  • +0466T — Insertion of chest wall respiratory sensor electrode or electrode array, including connection to pulse generator (List separately in addition to code for primary procedure)
  • 0467T — Revision or replacement of chest wall respiratory sensor electrode or electrode array, including connection to existing pulse generator
  • 0468T — Removal of chest wall respiratory sensor electrode or electrode array.

For the service you’ve described, you should report 64568 and +0466T.

For follow-up services involving the revision and/or replacement of the hypoglossal nerve stimulator and chest wall respiratory sensor electrode, you should report one of the above category three codes along with the following respective revision and removal of hypoglossal nerve stimulator codes:

  • 64569 — Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator
  • 64570 — Removal of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator.

Scenario 2: Ensure Specific Follow-Up of Chief Complaints  

Our otolaryngologist lists the chief complaint (CC) for all follow-up visits using just “f/u” – we have never had an issue collecting payment, but our coder is concerned that this isn’t compliant. Can you advise?

Answer: The chief complaint is not thorough enough, and if the physician writes the same thing on every record, he could risk accusations of “cloned notes” or providing medically unnecessary services.

Insurers consider the chief complaint to be a concise statement that describes the symptom, problem, condition, diagnosis, or reason for the E/M encounter. It is typically stated in the patient’s own words. It’s imperative, therefore, to avoid “follow-up” as a catch-all complaint.

An example for otolaryngology practices might include increased nasal congestion or throat pain. Just stating “follow-up” is inappropriate. It is appropriate, however, to say “follow-up nasal congestion.”

If a patient is coming in for lab tests, put the reasons (signs and symptoms) that the lab tests were performed as the chief complaint. Whenever in doubt, the patient’s signs and symptoms are safe add-ons to the “follow-up” in the chief complaint.

In addition, whether the cloned documentation is handwritten, the result of a pre-printed template, or due to electronic health records (EHRs) use, cloning of documentation will be considered misrepresentation of the medical necessity requirement for coverage of services. Therefore, you should never have documentation with the same information listed over and over again, because this could create compliance issues. Speak with the physician in question and educate him on appropriate coding techniques to avoid this issue in the future.

Scenario 3: Pay Attention to Circumstances of Postop Pain Before Determining Dx Code

A patient complains of pain in and around the ethmoid sinus two days following an ethmoidectomy. What diagnosis code should I use to report this condition?

Answer: You’ll want to consider the circumstances surrounding the patient’s pain before incorrectly reporting a diagnosis code such as J34.89 (Other specified disorders of nose and nasal sinuses).

Since this is a postoperative symptom, you should report the patient’s pain diagnosis accordingly. The 2019 ICD-10-CM guidelines instruct you to report a postoperative pain code from category G depending on whether the pain is related to a postoperative complication. Assuming the provider does not document a postoperative complication that can account for the patient’s pain, you should abide by the following guidelines in Section 1.C.6.b:

“Postoperative pain not associated with a specific postoperative complication is assigned to the appropriate postoperative pain code in category G89 (Pain, not elsewhere classified).”

However, before reporting a code under category G89, consider this additional guideline:

“Routine or expected postoperative pain immediately after surgery should not be coded.”

It’s up to your provider to appropriately document whether the patient is experiencing typical postoperative pain, or whether the pain is atypical for an ethmoidectomy procedure. Assuming the provider documents that the pain is atypical, you should report code G89.18 (Other acute postprocedural pain).

Contributing Editor: Brett Rosenburg

Learn More

Put an end to avoidable denials, needless audit risks, and debilitating payback demands with your monthly subscription to Otolaryngology Coding Alert. Every issue of this indispensable resource delivers high-impact tips and how-to reporting tutorials to guide you over your reimbursement hurdles and help you conquer the revenue-risking challenges that threaten your claims and compliance success.

The Coders’ Specialty Guide 2019: Otolaryngology/Allergy includes all CPT® and HCPCS codes relevant to otolaryngology, simple descriptions that explain each code, expert advice for assigning codes, Medicare reimbursement details, diagnosis codes crosswalk, applicable modifiers, CCI edits, global days, code index, hundreds of anatomical illustrations, and more.



Elizabeth works on an array of projects at TCI, researching and writing about modern reimbursement challenges. Since joining TCI in 2017, she has also covered the nuts and bolts of cybersecurity, compliance with federal laws, and how to tap into the advantages of telehealth services.

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