Coding and Documenting Advice from the Experts

Advancements in Otolaryngology Affect Coding

We’ve seen significant advancements in three areas of otolaryngology: (1) surgical precision, like microflap surgery and Gray’s mini-thyrotomy, (2) technology development, including new augmentation materials and fiber-based lasers, and (3) site of service, which has changed from the OR to office-based procedures, said Dr. Rosen. These changes are great for us and our patients, but they are really difficult from a coding perspective because we are way ahead of the coding curve.

It’s very hard to code for a new surgical procedure if it doesn’t have a code, and some of our current codes are based on very antiquated techniques, continued Dr. Rosen. Therefore, about six years ago, Mark Courey, MD, who is the Director of Laryngology at the University of California, San Francisco Voice Center, and myself, in conjunction with the Committee on Speech, Voice and Swallowing Disorders of the American Academy of Otolaryngology-Head and Neck Surgery, started the very long, laborious process of getting new microlaryngeal codes. Some of our colleagues will argue that they were getting better pay when they used unlisted codes, but I think as a whole, we are better off having new and specific codes.

For example, I suspect many ENTs are now using microflap CPT codes 31545 and 31546, instead of 31541, as the codes are very straightforward and allow them to bill bilateral, which was not possible before, said Dr. Rosen. (31545, WRVU 6.3 and 31546, WRVU 9.73 are for laryngoscopy direct, operative with microscope or telescope with submucosal removal of non-neoplastic lesion(s) of VF, reconstruction with local tissue OR grafts, includes obtaining autograft.)

Coding always lags behind both new technology and new procedures, said Dr. Setzen. When we use a new technology or procedure in otolaryngology that doesn’t have a specific code, we have to negotiate with the American Medical Association and other specialty societies to create a new code that is fiscally neutral-that is, money must be taken from one source and allocated to another to allow for reimbursement.

In the event that there is no specific CPT code, then an unlisted CPT code must be used, continued Dr. Setzen. The only problem with an unlisted code is that the insurance companies often don’t understand it, pay you minimally, and demand a tremendous amount of paperwork to back it up. It’s nicer to have a definite code with a value to it, rather than use an unlisted code.