Otolaryngology (ENT) relates to the four parts of the respiratory system i.e., ears, nose, sinuses, and throat. An ENT specialist would typically handle medical health concerns relating to the head and neck, especially these four parts. Otolaryngology coding requires a coder to have knowledge about a huge number of procedures and examinations relating to the ears, nose, sinuses, and throat. To fully understand the ENT coding guidelines, coders must have a certain level of understanding of the anatomy and the procedures conducted by ENT specialists. Otolaryngology (ENT) coding is a lot more than memorizing the most common ENT CPT codes and using them regularly for all bills and claims. ENT CPT codes greatly depend on the coder’s ability to properly read the documentation provided by otolaryngologists. By correctly these challenges, many commonly made billing errors can be reduced. Some of the common errors are:
Common Otolaryngology (ENT) Coding Mistakes
Inability to Understand ENT Anatomy
Physicians can perform procedures in a number of sinuses (e.g., sphenoid, frontal, maxillary, and ethmoid), and coders need to understand how to code procedures on each of those sinuses. Coders need a strong understanding of anatomy when coding otolaryngology procedures. Coding these procedures correctly is difficult for coders who lack knowledge of ENT anatomy. Coders have to carefully read the documentation and choose the most suitable code or codes for the procedure. Physicians and surgeons will mention certain landmarks on their notes corresponding to the sinuses they have worked on. A well-trained coder will be able to identify the sinuses with the help of the anatomical location mentioned by the surgeon to accurately assign the codes.
Inability to Understand Notes
If a coder does not thoroughly go through the notes detailing the entire procedure, the person is sure to miss important information and assign the wrong CPT codes for ENT procedures. Summaries are only intended to describe the procedure in a nutshell. They do not do justice to the entire process including complications or health concerns that the patient may have identified. In ICD-10, we have more than 85,000 CPT codes to accurately report different medical procedures, visits, or examinations. The reason for adding more codes is to increase the depth with which patient records are maintained. Coders’ inability to understand notes can greatly affect the choice of CPT codes for reporting the procedure.
Wrong Codes Selection
Coders can run into various trouble spots when coding endoscopic sinus surgeries. For example, coders often miscode maxillary antrostomy by reporting CPT code 31267 (nasal/sinus endoscopy, surgical, with the removal of tissue from maxillary sinus) instead of code 31256 (nasal/sinus endoscopy, surgical, with maxillary antrostomy). For coders to report code 31267, the physician must remove ‘tissue’ (e.g., polyps, fungus ball, mucocele) within the maxillary sinus. The physician must remove the tissue from within the maxillary sinus and not around the opening (i.e., ostium), of the maxillary sinus.
Balloon Sinuplasty Procedures
Physicians can use a relatively new procedure called balloon sinuplasty to open inflamed sinuses in patients with chronic sinusitis who have not responded to medication. The actual coding for the procedures is easy because the codes are straightforward. The problem is that many payers do not reimburse for these procedures so coders are reluctant to use the ostium balloon dilation codes. Although the codes are clear-cut, coders can still get tripped up by physician documentation, Ellis says, especially if the coder only reads the summary at the beginning of the operative report.
Other Common Coding Errors
- Another common error involved billing cautery of the turbinates. Coders should report turbinates procedure using CPT code 30801 (ablation, the soft tissue of inferior turbinates, unilateral or bilateral, any method [e.g., electrocautery, radiofrequency ablation, or tissue volume reduction]; superficial) or 30802 (ablation, the soft tissue of inferior turbinates, unilateral or bilateral, any method [e.g., electrocautery, radiofrequency ablation, or tissue volume reduction]; intramural).
- Coders commonly use code 30140 for a submucous resection (SMR) instead. Sometimes, this error is because the surgeon’s verbiage at the beginning of the report misleads the coder. The surgeon may call the procedure an SMR even though he or she clearly documented using cautery or radiofrequency.
- Coders who fail to read the entire operative report may also incorrectly report codes for tissue removal by billing codes that do not include tissue removal (e.g., codes 31256 and 31287). In some cases, coders should report a more extensive code (e.g., 31267, 31288) instead.
There are regular changes in coding guidelines. It is always a good practice to watch out for industry benchmarks in order to identify gaps in the quality of billing and coding for your practice. We conduct regular training to keep our coding team update on changes and to address challenges that they may be facing in using certain codes or reporting certain procedures. To know more about Otolaryngology billing and coding services, please get in touch with us!