Know Your Nose: Coding the Nose and Sinuses

Know Your Nose: Coding the Nose and Sinuses

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 1 9/8/2017 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 2 9/8/2017 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 3 9/8/2017 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 4 9/8/2017 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 5 9/8/2017 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) 6 9/8/2017 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 7 9/8/2017 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 8 9/8/2017 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 9.

View Full Text

Details

  • File Type
    pdf
  • Upload Time
    -
  • Content Languages
    English
  • Upload User
    Anonymous/Not logged-in
  • File Pages
    9 Page
  • File Size
    -

Download

Channel Download Status
Express Download Enable

Copyright

We respect the copyrights and intellectual property rights of all users. All uploaded documents are either original works of the uploader or authorized works of the rightful owners.

  • Not to be reproduced or distributed without explicit permission.
  • Not used for commercial purposes outside of approved use cases.
  • Not used to infringe on the rights of the original creators.
  • If you believe any content infringes your copyright, please contact us immediately.

Support

For help with questions, suggestions, or problems, please contact us