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.