Documenting Signs or Symptoms, Patient History Key to Payment for Late Repair of Nasal Fracture
Published on Sat Jan 01, 2000
When a patient who years earlier had a nasal fracture requires treatment to repair damage originally caused by the fracture, otolaryngologists must code the patients signs or symptoms carefully. Carriers are likely to deny the claim as cosmetic unless the diagnosis codes and supporting documentation clearly indicate the procedure was medically necessary.
Getting the diagnosis codes right is critical in these situations, says Emily Hill, PA-C, CPC,, the managing partner of Hill and Associates, a coding reimbursement firm in Wilmington, N.C. A patient with a deviated septum, for example, amy be examined by the otolaryngologist, who then decides to perform a septoplasty (30520, septoplasty or submucous resection, with or wothout cartilage scroing, contouring or replacement with graft). To get paid for the procedure, Hill says, the otolaryngologist will need to provide proof that it was not performed for cosmetic reasons. In practical terms, that means providing the correct diagnosis codes.
For example, a young man breaks his nose in a car accident. The fracture (802.0, fracture of nasal bones, closed) is treated in a closed manner (21320, closed treatment of nasal fracture, with stabilization). Because of the accident, he has a deviated septum and experiences frequent episodes of sinusitis and mouth breathing. Through the years, he has been treated several times for acute sinusitis (461.9), but the breathing problems and the frequency of sinus infections continue to worsen. The acute sinusitis was treated occasionally via nasal endoscopy (31231, nasal endoscopy, diagnostic, unilateral or bilateral[separate procedure]), while at other times, the patient received an exam and prescription.
Eventually, as the problem worsens, the otolaryngologist talks to the patient,re-examining his history. The physician discovers the nasal fracture and decides to perform a septoplasty.
When the otolaryngologist bills for the procedure, the deviated septum (470) certainly should be reported, but it may not be enough. Just because the septum is deviated doesnt mean the carrier will pay to have the patients nose straightened. So a deviated septum needs a supporting diagnosis, or signs or symptoms, Hill says. The carrier needs reasons, such as the patients problems with breathing, possibly sinusitis or chronic rhinitis (472.0). If the problem is that they have a resulting deviated septum, theyre going to have to show that its creating health related concerns for the patient, other than just looks.
Depending on the circumstances, these diagnoses could include chronic rhinitis, chronic sinusitis (473.2, ethmoidal; 473.3 sphenoidal), or signs or symptoms such as mouth breathing (784.9). Otolaryngologists also should add ICD-9 code 905.0 (late effect of fracture of skull and face bones) to the septoplasty code to indicate that there was a previous nasal fracture and that the current problem is directly linked to it, Hill adds. Another [...]
