Wiki ent cpt codes

[jocoffey]

I have 2 questions 1- is it appropriate to bill 95867 for the primary surgeon
( i was told that this code should not be billed thru a workshop)
and 2nd- is cpt code 69670(mastoid obliteration) inclusive of a tympanoplasty(69644)? I need any help or where info can be found regarding
this. Thanks in advance.

 

[JenniferB7]

1. The workshop is correct. It sounds like you are trying to bill 95867 for intraoperative nerve monitoring, in which case the correct codes would be 95940-95941. If so, if you read the CPT guidelines under Intraoperative Neurophysiology (CPT codes 95940, 95941), it states that when intraoperative nerve monitoring is "performed by the [primary] surgeon or anesthesiologist, it is included in the surgeon's or anesthesiologist's primary service codes and not separately reported."

2. In response to CPT code 69670, it has a "separate procedure" distinction in CPT, which indicates that it is commonly part of or integral to a more major or total procedure or service. You can reference this in the "Separate Procedure" section in the Surgery Coding Guidelines found before the 10000 section codes. You can only bill 69670 if it is "carried out independently and and distinct/unrelated from other procedures performed." So, in this case, you would only bill 69644.

You can also reference the NCCI edits on the CMS website, which indicate that CPT 69670 is a component of 69644 (https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html0). While the NCCI edits indicate that correct usage of an appropriate modifier could override the edit, you would need strong medical documentation to support CPT 69670 being performed "independently and distinctly" from CPT 69644 since both procedures are being performed on the anatomical part.

Hope that helps!


Jennifer M. Connell, BA, CPC, CENTC, CPCO