Otolaryngology Coding Alert

Even though medical necessity is a driving force in receiving reimbursement for scar revisions, the level of repair ultimately determines the appropriate coding. So, follow the coding guidelines for three methods to ensure that you capture all the otolaryngologist's billable procedures. Determine Medical Necessity Otolaryngologists and coders must first determine whether the scar revision is medically necessary. Most payers will not pay for cosmetic procedures. If a scar impedes function, insurers will probably cover the service. If a patient requests a scar removal because he or she just doesn't like how it looks, however, the payer will likely refuse coverage. Most payers consider scar revision after an otolaryngologist removes a malignancy necessary aftercare and will usually cover these services, provided you include supporting documentation. For instance, a patient has a basal cell carcinoma on his lip, and the carcinoma is removed, leaving a scar. The carrier will likely cover the scar removal because the scar resulted from a malignancy. Report Lesion Code for Simple Repair When the otolaryngologist excises a scar that requires only a simple repair, report the appropriate lesion removal code based on the lesion's size. "Measure the size of the lesion at the widest dimension," says Susan Callaway, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C. You cannot add lesion codes together. "Bill each lesion removal separately," she says, which translates to coding each scar separately. In addition, CPT further categorizes the lesion excision codes by the lesion's type benign or malignant and location, says Julie Robertson, CPC, an otolaryn-gology coding and reimbursement specialist for University ENT Specialists in Cincinnati. A scar falls into the category of a benign lesion. For example, the otolaryngologist removes a painful 2.2-centimeter scar from the left side of a patient's nose. In this case, you should report 11443 (Excision, other benign lesion [unless listed elsewhere], face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm). The correct code is selected from the excision benign lesions section (11400-11471), based on the lesion's location and size. "These codes are for lesions of the skin and subcutaneous tissues only," Robertson says. Excision also includes simple closure, according to CPT's introductions to the excision benign lesions and excisions malignant lesions sections. Therefore, when an excision wound requires a simple closure, you should assign the appropriate excision code only. CPT bundles simple repair into the excision code. Use Repair,Excision Code for Complex/Int Repair For a wound that requires a complex or intermediate repair, report the repair and the excision. Unlike lesion codes, which are never added together, you should always add closure codes of like kind together. Combine multiple closures the otolaryngologist performs on the same body area and [...]