CPT 2001 Promises Greater Reimbursement With the Addition of New Otolaryngology Codes
Published on Fri Dec 01, 2000
CPT 2001 includes several important changes for otolaryngologists, including new codes for repair of nasal vestibular stenosis, osteotomy with genioglossus advancement and implantation of bone-attached cochlear devices. Because these procedures were previously billed using either inaccurate or unlisted codes, the new codes are being welcomed by otolaryngologists and their coders.
Coinciding with the release of CPT 2001, the Health Care Financing Administration (HCFA) published its final rule (which contains the 2001 fee schedule) in the Nov. 1, 2000, Federal Register. In addition to boosting the relative value unit (RVU) conversion rate from $36.6137 per RVU in 2000 to $38.2581 per RVU in 2001 (a 4.4 percent increase), the fee schedule also includes coverage and reimbursement information about the new CPT codes. The following five procedures relate directly to otolaryngologic practice.
New Code Review
1. Repair of nasal vestibular stenosis. Code 30465 (repair of nasal vestibular stenosis [e.g., spreader grafting, lateral nasal wall reconstruction]; 21.58 RVUs) may be the most welcome CPT addition. The procedure is performed on patients who have developed nasal stenosis (i.e., scarring or contracture, causing an internal narrowing of the nasal valve), often as a result of prior surgery. This affects the patients breathing, so the otolaryngologist must revise the tip of the nose.
Until now, this procedure has been coded using rhinoplasty codes, but carriers often categorize such procedures as cosmetic, even though the procedure is performed to improve the patients breathing, says Lee Eisenberg, MD, an otolaryngologist in Englewood, N.J., and a member of CPTs editorial panel and executive committee.
This is a great code that has been needed for a long time, Eisenberg says. Everyone used to look at this kind of work as cosmetic, but with the new code, it will be correctly seen as a functional repair.
CPT notes, however, that 30465 does not include obtaining graft for the procedure and instructs otolaryngologists to see codes 20900-20926 and 21210 (as appropriate). In addition, the code is used to report a bilateral procedure. If the procedure is performed on one side only, modifier -52 (reduced services) should be appended.
2. Osteotomy with genioglossus advancement. This new code (21199, osteotomy, mandible, segmental; with genioglossus advancement; 27.53 RVUs) relates specifically to a procedure performed on obstructive sleep apnea patients, says Randa Blackwell, a coding and reimbursement specialist with the department of otolaryngology at the University of Maryland in Baltimore.
In this procedure which Blackwell describes as the standard of care for patients who have already had uvulopalatopharyngoplasty that did not eliminate the problem the chin is moved and the tongue is advanced to lessen or eliminate airway obstruction.
This code will make otolaryngologists happy, Blackwell says, noting that carriers, including Medicare, do not cover the [...]
