Wiki Dilation of Eustachian Tubes

[grnis7]

I need opinions please. I work for an ASC and was sent the attached operative report by an ENT. When I received it and read the report I sent it back to him stating no way does his documentation justify procedure number 8, a Pharyngoplasty. He and I have been going round and round for two days now. He says yes it does and I have told him I will not bill that procedure as it is not justified. I will only bill an unlisted code for the dilation of the Eustachian tubes which is what he actually dictated. The procedure code for what he stated in the procedure section is 42950-Pharyngoplasty( Plastic or reconstructive operation on pharynx). I am wanting to bill 69799-unlisted procedure, middle ear, as there is no procedure code for the dilation as of yet. This is a Medicare patient and by no means do I want go get audited. I am only able to send the two pages where he mentions this procedure, the entire report is too long.


HELP PLEASE

 

[JenniferB7]

I completely agree with you.

CPT deleted code 69400 for Eustachian Tube inflation; transnasal; with catherterization beginning in 2015. The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), who is responsible for physician board certifications in ENT, states the following:

Deletion of three Eustachian tube codes (69400, 69401, and 69405). To report the work of 69400 or 69405 an unlisted code, 69799, is recommended. For 69401, the appropriate Evaluation and Management office visit code is recommended. For more, visit our coding corner to access the CPT for ENT on this topic.​

Source: http://www.entnet.org/content/cpt-changes-2015-what-ents-need-know​

So, based on the pdfs you uploaded, I agree with coding the procedure as unlisted (CPT 69799), which is what CPT states as well in their parenthetical notes on page 427 of the 2017 CPT manual: [69400 has been deleted. To report, use 69799]. The documentation you presented certainly does not support CPT code 42950 for a pharyngoplasty, which is described in the Procedure Desk Reference as "The physician advances soft tissue of the posterior pharyngeal wall by suturing palatopharyngeal muscles. A flap of pharyngeal mucosa is then folded back upon itself to achieve further reconstruction. This procedure is performed usually to treat malignant neoplasm of oral cavity and pharynx."

Disclaimer: My opinion is based on the two pages of the operative note you provided. A review of the full operative note may result in a different opinion.

Hope this helps!

Jennifer M. Connell, CPC, CENTC, CPCO, CPPM, CPMA, CPB, CPC-P, CPC-I