Otolaryngology Coding Alert
Must You Always Follow CCI Edits?
Question: When specialty-society guidelines differ from National Correct Coding Initiative (CCI) edits, a commercial payer said we have to defer to the CMS bundles. Our contract does not stipulate that we must follow CCI edits. The representative claims that because we are following society guidelines, we are -unbundling.- We follow CCI for Medicare, Tricare and Medicaid. When billing commercial payers, do we have to follow CCI edits or CMS guidelines? Virginia Subscriber Answer: Many coding experts recommend that you code uniformly, meaning that you follow CMS guidelines and CCI edits for all payers. Universal coding keeps you HIPAA-compliant and protects you from accusations of coding for payment. Because payers do not use the same claim edits, some coders prefer to code per insurer. These practices either employ large billing staff who can focus on various regulations or are small and handle a low volume allowing this specificity. If the edits contradict specialty-society guidelines, you should work with the society--such as the American Academy of Allergy, Asthma and Immunology; the American College of Allergy, Asthma and Immunology; or the Joint Council of Allergy, Asthma and Immunology--and the payer to alert them to the inappropriate edit. Before reporting two bundled codes, make sure documentation justifies billing them separately.
Otolaryngology Coding Alert
- Rehaul Your Superbill With ICD-9 2008's ENT-Intensive Changes in 5 Easy Steps
You'll need side-specific details to use new hearing loss codes
If you love attention, ICD-9 2008 [...] - ICD-9 2008 Update:
Identify Area With Specific Dysphagia, Lymphoma Dxs
Code 787.20 comes to the rescue when ENT can't discern problem stage
When four specific dysphagia [...] - You Be the Coder:
4 Turbinate Procedures--How Many CPT Codes?
Question: An otolaryngologist does bilateral outfracture of inferior turbinates and bilateral cautery of inferior turbinates. [...] - Prepare for Your Starring Role in ICD-9 2008's Hearing-Focused Debut
Red flag 389.2, 787.2 in your computer system to avoid post-September invalid-code denials
There are only [...] - READER QUESTIONS:
Combat 69801 POS Denials With Ammo
Question: The Otolaryngology Coding Alert, Vol. 9, No. 4, article on Decadron injections lists 69801's [...] - READER QUESTIONS:
Use V5264 When You Break Down Dispensing
Question: Is there a code for making a hearing aid (HA) mold? How should we [...] - READER QUESTIONS:
Stick With 1 Unit of 31233-50
Question: A surgeon insists on billing bilateral nasal endoscopies 31233, 31235 and 31237 with modifier [...] - READER QUESTIONS:
Identify Target to Pinpoint Injection Code
Question: An otolaryngologist injects Kenalog into a hemangioma located in the ear canal. Should I [...] - Use 25 to Overturn Denial of OV With 95115 or 95117
Medicare now allows same-day E/M service and allergy injection -- and your payers should, too
Before [...] - Educate Payers on CMS' New Same-Day E/M-Shot Policy
These ready-to-go appeals letters will help you get your office visits paid
Combat denials for office [...] - ICD-9 2008 Update:
Find Out When to Report 2 Allergy Symptoms
Don't code -runny nose- every time you see one
Although new entries for -runny nose- and [...] - You Be the Coder:
Diagnosing Multisystem Reactions
Question: After a bee stings a 12-year-old boy with a history of atopic dermatitis (691.8, [...] - Stop Shying Away From Charging for Phone Calls
Society supports payers reimbursing telephone care
If you choose to bill for allergist-made telephone calls, [...] - READER QUESTIONS:
Antigens--Should You Use 1 Line?
Question: How should I bill preparation of three separate 10-dose immunotherapy vials (using different antigens) [...] - READER QUESTIONS:
Take These Steps to Show PFSH Checked
Question: Can I count past, family, social history (PFSH) items that I record using a [...] - READER QUESTIONS:
Must You Always Follow CCI Edits?
Question: When specialty-society guidelines differ from National Correct Coding Initiative (CCI) edits, a commercial payer [...] - READER QUESTIONS:
Look Beyond HPI for Chronic Condition
Question: The 1997 audit guidelines state that I can reach an extended history by updating [...] - READER QUESTIONS:
Don't Bill Separately for 94060 Puffs
Question: Which J code should I report for the medication that we administer in the [...]
