Otolaryngology Coding Alert

Although the add-on designation in CPT applies to many procedures and services ranging from E/M (prolonged services) to integumentary (lesion removal and skin grafts) to use of equipment (operating microscope and stereotactic guidance) the codes all share the following characteristics:

They are denoted in the CPT book with a + to the left of the code

The CPT code descriptor will include the words list separately in addition to code for primary procedure or each additional code

They should always be used with other, primary procedures

They should never be listed as a primary procedure

They should never be listed with modifier -51 appended

Payment for these services should never be lowered as a multiple-surgery reduction.

Many of these codes involve measuring or counting. Coders must pay close attention to the information in the operative report and make sure the otolaryngologist accurately describes not only the procedure performed but also, for instance, the size of a repaired wound or the number of excised lesions, says Randa Blackwell, coding specialist with the department of otolaryngology at the University of Maryland in Baltimore.

For add-on codes to be used correctly, the operative report has to be specific, Blackwell says, pointing to destruction-of-lesion codes as an example. When one benign or premalignant lesion is destroyed, the correct code is 17000 (destruction by any method, including laser, with or without surgical curettement, all benign or premalignant lesions [e.g., actinic keratoses] other than skin tags or cutaneous vascular proliferative lesions, including local anesthesia; first lesion). Any additional lesions destroyed during the same operative session are coded 17003 (... second through 14 lesions, each [list separately in addition to code for first lesion]). In other words, after the initial lesion is destroyed, 17003 may be reported separately for any additional lesions subsequently destroyed. If four lesions were destroyed, the session should be coded as follows:

17000
17003x3

Note: Some carriers instruct physicians to list 17003 three times, with modifier -59 (distinct procedural service) on the second and third code listed. Others may prefer a 3 in the units box of the HCFA 1500 claim form.

Tip: Carefully note the wording of all codes to determine if they are add-on codes. For example, the next code in the lesion destruction series, 17004 ( 15 or more lesions), is not an add-on code. Furthermore, when this code is used, neither 17000 nor 17003 should be reported.

The only way the coder can correctly bill for this service is if the otolaryngologist [...]