9/8/2017
Know Your Nose: Coding the Nose and Sinuses
Presented by: Melissa Hainz, CPC Date: September 20, 2017 AOA-35
Know Your Nose: Coding the Nose and Sinuses
• Coding Basics
• Coding Conundrums
• Maximizing Collections
Rhinoplasty/Sinus Coding Basics
Not all codes are created equal • Which structures are the focus? • Primary vs. Revision • Cleft Lip/Nasal Deformity • Septoplasty • Other options • Sinus
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Rhinoplasty Coding Basics
Which structures? •Tip • Nasal Valve (Vestibule) – Lateral or alar cartilages • Bone – Nasal bones vs. bony septum • Septum
Rhinoplasty Coding Basics
Primary vs. Revision • Primary = 1st rhinoplasty – 30400 = lateral/alar cartilage and/or elevate tip – 30410 = complete (30400 plus bone) – 30420 = with septoplasty • Revision = 2nd+ rhinoplasty – 30430 = minor revision (tip) – 30435 = intermediate revision (bone) – 30450 = major revision (tip and bone)
Rhinoplasty Coding Basics
Cleft Lip/Nasal Deformity • Two options: – 30460 = tip only – 30462 = tip, septum, and osteotomies • Diagnosis of congenital anomaly (or history of corrected anomaly) must be included
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Rhinoplasty Coding Basics
Septoplasty • May include bone: – Maxillary crest, vomer, or perpendicular plate of ethmoid • Codes: – 30520 = septoplasty (use with revision rhino) – 30420 = primary rhinoplasty w/ septoplasty • Hx of prior septoplasty only? – No impact on rhino code
Rhinoplasty Coding Basics
Other Options • 30465 = Repair vestibular stenosis – Spreader graft (most common) – Lateral nasal wall recon/strengthen nasal valve • Alar batten grafts • Lateral crural strut grafts • Butterfly grafts
Rhinoplasty Coding Basics
Other Options • Fracture (acute) – 21325 = uncomplicated open treatment – 21330 = complicated w/ fixation
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Sinus Coding Basics
Sinuses/Laterality • Maxillary – 31256 = w/o tissue – 31267 = w/ tissue •Ethmoid – 31254 = partial – 31255 = total • Sphenoid – 31287 = w/o tissue – 31288 = w/ tissue • Frontal – 31276
Sinus Coding Basics
Turbinates/Laterality • Inferior – 30130 = resection – 30140 = submucous resection – 30801* = superficial ablation – 30802* = intramural ablation – 30930 = therapeutic fracture • Middle – 30999* = per AMA • Superior – 30999* = per AMA (rare)
*modifier 50 not allowed
Rhinoplasty Coding Conundrums
This isn’t a typical patient… • Cosmetic changes too? • Sinus concerns • Septal transplant • Cancer, fracture, other deformities
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Rhinoplasty Coding Conundrums
Cosmetic Requests Too? • Make clear what is functional and what is cosmetic – Focus on structures – Use code options for functional portions to your advantage • Documentation is key!
Rhinoplasty Coding Conundrums
Sinus Problems • Let your Rhinology colleagues be involved – Referral system can benefit both divisions – Possible more than turbinates causing a problem? • FESS/turbinates – Rhinologist should document and bill separately
Rhinoplasty Coding Conundrums
Septal Transplant • Account for additional work, time and skill – Modifier 22 • Use on code that includes the septoplasty • Include a clear, separate statement explaining procedure, consequences of not performing it, increase in time, etc. – 20912 = nasal septum cartilage graft • Bill with appropriate modifier (XU vs. 59) • Include comment on CPT • Additional statement like mod 22 is helpful
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Rhinoplasty Coding Conundrums
Non-Traditional Deformities: Watch your Diagnosis Codes • Tumor reconstruction – Mohs –JNA • Past fracture/Trauma – Sequela vs. non-treated vs. malunion)
Maximizing Collections
Why can’t I get paid? • Terminology • Insurance • Pre-auth process • Split case? • Back-end process
Maximizing Collections
Coding Physician terminology terminology
• Coding terminology is used by insurances – Focus on key words or phrases in coding titles – CPT 30465 example: • Vestibular stenosis vs. Nasal valve collapse • Spreader graft most common but other procedures can be used • Billing software (EncoderPro, Supercoder)
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Maximizing Collections
Maximizing Collections
Insurance
• Rhinoplasty codes considered cosmetic – Uphill battle from first visit • Bulky insurance policies – Continual revisions – Don’t always make clinical sense • Plan exclusions
Maximizing Collections
Pre-auth Process • Dedicated Managed Care/Coding/Billing team – Check each patient’s insurance for policies and exclusions – Submit accurate/appropriate CPT and dx codes – Submit thorough intial eval note and photos with pre- auth request – Non-covered service forms • Time/effort on pre-auth is worth more than on back-end
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Maximizing Collections
Split Case? • 2 separate reports – Same as if two surgeons are involved: • Ablative and Reconstructive • Rhinoplasty and Sinus • Functional and Cosmetic – Okay to refer to the alternate report for prep, closure, etc. – Only send the functional report to insurance
Maximizing Collections
Back-end Process • Appeal & follow-up efforts significantly reduced if pre-auth process is efficient and consistent • Track denials – Catch insurance trends • Standardize appeal letters where possible
Coding Functional Rhinoplasty
Summary • Understand your codes • Be transparent in your documentation with your operative plan • Surround yourself with competent coders and support staff • Do the legwork before the patient heads to surgery
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Know Your Nose: Coding the Nose and Sinuses Presented by: Melissa Hainz, CPC Email: [email protected]
Date: September 20, 2017 AOA-35
Coding Functional Rhinoplasty
References
• Slide 4 Images:
– https://media1.britannica.com/eb-media/78/74278-004-EC92F4A9.jpg
– https://www.getbodysmart.com/ap/respiratorysystem/nose/nosecartilages/images/thumbnail.gif
• Slide 7 Image:
– http://teachmeanatomy.info/wp-content/uploads/Anatomy-of-the-Nasal-Septum-Bones-and-Cartilage.jpg
• Slide 10 Image:
– https://humananatomy-libs.com/wp-content/uploads/2017/06/anatomy-diagram-of-the-nose-human-anatomy-sinus-anatomy-spaces- between-the-bones-around-the.jpg?9d7bd4
• Slide 11 Image:
– https://humananatomy-libs.com/wp-content/uploads/2017/06/anatomy-diagram-of-the-nose-easy-edit-vector-illustration-human-nose- stock-vector-142194046.jpg?9d7bd4
• Slide 19 Images:
– Encoder Pro 2015 for CPT 30465
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