Repair of a Semi-Circular Canal Dehiscence with ENT

Question:

We are doing a combined case with ENT and are not sure how to code it. The patient has a semi-circular canal dehiscence of the temporal bone. ENT is going to do the approach and I’m going to do the repair of the defect with local bone. We will use mesh to reconstruct the cranial defect for closure. How do we code this procedure?

Answer:

It is difficult to provide exact CPT codes unless we see an operative note. That said, there is not a code for this exact procedure. An unlisted code will likely be necessary. Another thought is to use the exploratory craniotomy code, 61304, with modifier 62 (two surgeons).

*This response is based on the best information available as of 5/28/20.

Nasal Endoscopy and Epistaxis Control

Question:

Can we charge a 31231 and a 30901, 30903, or 30905 if the scope is withdrawn and then the cautery is done?

Answer:

No.  CPT 31231 is a diagnostic procedure and includes the parenthetical statement “separate procedure.”  That means 31231 is included in a more definitive therapeutic/treatment procedure at the same operative session.  Report either CPT code 31231 or 30901 (or 30903 or 30905), but not both codes.

*This response is based on the best information available as of 05/28/20.

Billing Telephone Calls Longer than 30 Minutes

Question:

We cannot locate a response from any reliable coding resource about how to bill telephone calls lasting more than 30 min. Do you have any guidance on this topic?

Answer:

Although telephone calls for both new and established patients are temporarily billable during the current COVID-19 public health emergency, there is not a way to bill for additional minutes over 30 for a phone call. Telephone calls (99441-99443) can only be billed at one unit a day andonly include the time for the billing provider talking to the patient, not staff time talking to the patient.

Although prolonged service codes are listed as billable for telehealth visits, telephone calls are not considered telehealth services, so prolonged service codes would not apply for billing to Medicare. However, commercial payors may have different billing flexibilities during this crisis, so you will want to check with your commercial payors.

*This response is based on the best information available as of 4/30/20.

Billing Telehealth Post Op Visits

Question:

I am trying to find a resource that addresses telehealth billing in the post-operative period.  Is it possible to bill a post-op follow-up telehealth video visit that is reimbursable in the post-operative/global period?

Answer:

If you are seeing the patient within the global period of a surgery performed by one of your surgeons, then a visit (in person or via telehealth) would only be billable if the visit was unrelated to the surgery. In other words, if a face-to-face post op visit wouldn’t be billable, then a telehealth post-op visit is not billable. If you are billing a 99024 for reporting purposes, then you do not need a modifier 95 and use place of service 11 or 22 should be used on the claim.

If you do have an unrelated diagnosis (not complication) for a visit within the global period (eg acute appendicitis during the global for a thyroidectomy), then you would bill the telehealth visit with a modifier 24 (along with any modifier to indicate telehealth – this varies by payor).

*This response is based on the best information available as of 4/30/20.

Meniscal Repair and Meniscectomy

Question:

Can I bill for a medial meniscus repair and a lateral meniscus meniscectomy done on the same knee? I see CMS has an NCCI edit between the two codes, 29881 and 29882.

Answer:

Yes, you may report both codes and append modifier 59 to indicate the procedures were performed on different anatomic sites. CPT, AAOS, and NCCI consider the compartments of the knee to be distinct anatomic structures.

*This response is based on the best information available as of 03/05/20

Coding Both Dix-Hallpike and the Epley Maneuver

Question:

I billed 95992 (Epley) and 92532 for the Dix-Hallpike I did. I got paid for 95992 but not 92532. Should I have used a modifier to get paid and should we appeal the denial?

Answer:

No. CPT 92532 is for positional nystagmus testing without a recording such as what you did for a Dix-Hallpike maneuver. CPT allows coding both 95992 and 92532 together. That said, Medicare, and most payors, consider this service included in the E/M or other service (95992) code you reported and not separately payable. .

We consider the performing the Dix-Hallpike, without a permanent recording, to be part of the exam performed and not separately billable. We do not recommend appealing the denial.

*This response is based on the best information available as of 02/20/20.