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Otolaryngology Coding Alert

Reader Questions:

Use 43499 for Zenker's Diverticulum

Published on Mon Jan 17, 2011

Question: How do I code for removal of a Zenker's diverticulum when my physician performed the procedure endoscopically? Can I still use 43130?Answer: No. You won't find any code for the endoscopic removal of the Zenker's diverticulum. You would not use 43130 (Diverticulectomy of hypopharynx or esophagus, with or without myotomy; cervical approach) because it describes an open procedure. Instead, you will need to use an unlisted procedure code such as 43499 (Unlisted procedure, esophagus).Keep this CPT instruction in mind: "Don't choose a CPT code that merely approximates the service provided." This rule is key for compliant coding; however it leaves you with tough job of submitting a claim without a procedure-specific code.When you file a claim using an unlisted procedure code you should include a cover letter stating why you are using the unlisted code. This separate report should explain in simple straightforward language exactly what the physician did.In [...]
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