Otolaryngology Coding Alert

Otolaryngologists can now bill for bilateral radical neck dissections (RND) in addition to certain glossectomy, laryngectomy and parotid codes thanks to the most recent version of the National Correct Coding Initiative (NCCI) version 9.0, effective Jan. 1-March 1. Despite the initial good news, the more than 20,000 additions bundle:
new HCPCS cerumen removal code G0268 into numerous ear procedure and services codes
revised ventilating tube removal code 69424 into ear procedure codes
benign lesion excision codes 11400, 11420 and 11440 with layered and complicated closures 12031-12057. Modifier -59 Breaks RND Edit NCCI previously included RND code 38720 (Cervical lymphadenectomy [complete]) in glossectomy codes 41135 (Glossectomy; partial, with unilateral radical neck dissection), 41140 ( complete or total, with or without tracheostomy, without radical neck dissection), 41145 ( complete or total, with or without tracheostomy, with unilateral radical neck dissection) and 41150 ( composite procedure with resection floor of mouth and mandibular resection, without radical neck dissection), and modified RND code 38724 (Cervical lympha-denectomy [modified radical neck dissection]) in 41135, 41140 and 41150 by not allowing the use of modifier -59. The new edits contain a modifier indicator of "1," which means a modifier can now be used. For third-party payers that do not follow NCCI, some coding experts reported bilateral RND with some success. "I would fight the denials and sometimes win," says Julie Robertson, CPC, an otolaryngology coding and reimbursement specialist for University ENT Specialists in Cincinnati. "These new edits should make it easier to get paid for procedures that insurers should have paid all along."

Therefore, when an otolaryngologist performs a complete glossectomy with an RND on the right side and a complete cervical lymphadenectomy on the left side, you should report both procedures with modifier -59 (Distinct procedural service) appended to the component code to indicate a different side. For the glossectomy, which includes a neck dissection on the right side, report 41145-RT(Right side). For the lymphadenectomy (second neck dissection) on the left side, assign 38720-59-LT(Left side). You may also report a bilateral RND in addition to the laryngectomy code (31365, Laryngectomy; total, with radical neck dissection) and a bilateral modified neck dissection with 31360 ( total, without radical neck dissection), 31365 and 31367 ( subtotal supraglottic, without radical neck dissection), 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. Before NCCI 9.0, you could not bill for the second neck dissection, Cobuzzi recalls. "Medicare now allows payment for the second procedure."

So, if an otolaryngologist performs a total laryngectomy with a bilateral radical neck dissection (radical on left, and modified RND on right), you should code an additional dissection, she [...]