Billing Best Practices: Useable Tips

ENT

Missing bilateral coding: nasal endoscopies are presented as unilateral. When performing bilaterally, use modifiers –RT and –LT (verify with local carriers as some may prefer -50).

Removal of impacted earwax: CPT code 69210 has been added in 2008 and is -51 exempt.

Myringotomy vs. tympanostomy: CPT code 69421 myringotomy describes actual no tube placement. The surgeon may inflate the eustachian tube of the patient. CPT code 69436 tympanostomy describes insertion of a ventilating or pressure equalizing (PE) tube.

Pain Management

Miscoding multiple injections: when coding multiple paravertebral facet joint injections at a single level, report only once.

Diagnostic vs. therapeutic injections: diagnostic injections are to determine the source of pain or discomfort of the patient. Therapeutic injections are given to relieve the pain the patient if experiencing. Choose ICD-9CM codes carefully.

Implant neuroelectrodes: CPT codes 64553-64581 are exceptions to the multiple procedure rule.

Practice Tips

Price out each procedure — including overhead, supplies, staffing, etc., and compare to the actual reimbursement rate. Use these figures when negotiating contracts with carriers.

Perform quarterly audits verifying correct coding practices.

Visit www.ascassociation.org and www.cms.hhs.gov/asc weekly for updates on coding, legislature and publications. There have already been changes to the coding rules, with four new HCPCS codes being added in the ASC payable drug file. They include:

> C9237: Injection, lanreotide acetate

> C9240: Injection, ixabepilone

> C9354: Ceritas collagen matrix, cm 2

> C9355: Neuromatrix nerve cuff, cm

When ASCs submit these codes for payment, they will be processed and paid using the same payment and claims processing policies issued for the 2008 revision to the ASC payment system.

Donna SanGiovanni, CPC, CHI, specializes in ASC coding at the St. Raphael Healthcare System/Hamden Surgery Center. She is founder and president of the Hamden, Conn. chapter of the American Academy of Professional Coders (AAPC).