Otolaryngology Coding Alert

This checklist will get you charging supplies without unbundling. Before you accept another biller's advice to increase revenue by reporting 99070, make sure you verify these details. 1. PE, POS Do Not Include Cost You can only bill supplies, such as with 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drug, supplies, or materials provided]), for which you incur a cost in the office (POS 11). For instance, if your ENT treats a nasal bone fracture with stabilization (21320, Closed treatment of nasal bone fracture; with stabilization) at an ambulatory surgical center (POS 24),the facility would bill the stabilization items (splints, gauze, etc.) because it would supply them, explains Karla M. Westerfield, business manager at Southeast Wyoming Ear, Nose & Throat Clinic PC, in Cheyenne. The AMA and Medicare already factor essentials into a code's values on the physician fee schedule. A procedure's office practice expense value units are usually more than its facility practice expense to cover the materials, explains Michelle Logsdon, CPC, CCS-P, at Falcon Practice Management in Toms River, N.J. "If you-re doing a procedure in the office that requires tools, surgical trays, or other supplies, the reasonable expectation is that you will be using equipment and that those costs have been accounted for in the price's procedure," Westerfield notes. For example, if the doctor does a biopsy in the office (such as 11100, Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion), he will use equipment to do it, and he may need to bandage the biopsy site. "We build a factor into our base cost for equipment replacement/purchasing, autoclaving, bandaging, etc." Exception: Private payers that do not follow the fee schedule might not include supply costs in their payments. In these cases, you could be paid for the item(s). 2. You Are Itemizing Care When you-re charging an E/M in place of a procedure code, however, the supply cost wouldn't be built in. For instance, if you opt to itemize nasal fracture care with office visit codes (99201-99215), you could charge the splint. Or, if an ENT provides the initial care only, and refers the patient out for global and postoperative care, you could report the office visit and splint. "If cast application or strapping is provided as an initial service (e.g., casting of a sprained ankle or knee) in which no other procedure or treatment (e.g., surgical repair, reduction of a fracture or joint dislocation) is performed or is expected to be performed by a physician rendering the initial care only, use the casting, strapping and/or supply code (99070) in [...]