Otolaryngology Coding Alert

Otolaryngology practices can now bill separately for two previously bundled audiometry codes thanks to the latest version of the national Correct Coding Initiative (CCI). Audiometry Bundle Broken With only five deletions, the edits reversed the six-year bundling of 92555 (Speech audiometry threshold) into 92553 (Pure tone audiometry [threshold]; air and bone). The American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) was pivotal in changing this long-standing edit. The organization worked extensively to explain to CMS that the two tests are distinct, separate procedures that should be reimbursed accordingly. CMS agreed with AAO-HNS and deleted the edit in version 8.3, effective Oct. 1-Dec. 31, 2002.

"This is a tremendous win for otolaryngology practices," says Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J. Doctors and coders need to fight erroneous edits through their local or national organizations. The Otolaryngology Coding Alert thanks the AAO-HNS for its dedication and work in deleting this bundle. Injection Procedures Bundled Despite only five deletions, the fourth-quarter CCI contains nearly 50,000 additions. Most new edits in version 8.3 involve the inclusion of about a dozen injection services in other, more extensive procedures. Hundreds of procedures, including debridement (11000, 11010-11044), biopsy (20200-20206), repair (12001-13160) and intubation (31500) now include:


36000* Introduction of needle or intracatheter, vein

36410* Venipuncture, child over age 3 years or adult, necessitating physician's skill [separate procedure], for diagnostic or therapeutic purposes. Not to be used for routine venipuncture

90780 Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour.

All of the above edits include a superscript of "1," meaning the procedures may be reported separately if the physician performs them at separate anatomic sites and you append modifier -59 (Distinct procedural service) to the component code. The edits basically state that the injection is included in the service unless it is unrelated to the procedure. In addition, you cannot bill office visit codes (99201-99215), office consultations (99241-99245), confirmatory consultations (99271-99275) and emergency department visits (99281-99285) separately when also reporting the observation codes (99218-99220, 99234-99236). These would be incorporated in a higher level of observation code based on including the work from the outpatient visit in the inpatient observation code. "Coding convention has traditionally allowed the reporting of one E/M service per day," Cobuzzi says. "These edits are consistent with that guideline."