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Topic: Break the chain of common coding errors for ENT procedures, part 1

Ambulatory Surgery Reimbursement Update, April 1, 2008

Ear, nose, and throat (ENT) procedures can be an excellent revenue generator for ASCs, but are often misunderstood and incorrectly coded, says Joanne Schade-Boyce, RDH, MS, CPC, ACS, PCS, vice president at FairCode Associates, LLC, in Towson, MD.

For example, coding sinus procedures correctly is difficult for coders who lack knowledge of ENT anatomy. "It's imperative to understand the anatomy," says Schade-Boyce. "When surgeons refer to certain landmarks in their operative notes, coders have to understand where that landmark is anatomically to determine which sinus has just been entered or exited. Knowing the anatomy not only secures accurate coding, but also justified revenue."

Many physicians perform endoscopic sinus surgery bilaterally. While sinus CPT codes are mostly unilateral, surgeons can perform the procedure in the left, right, or both sinuses. But ASCs tend to generate claims for unilateral procedures even though the physicians actually performed the procedures bilaterally, Schade-Boyce says, which results in a significant loss of reimbursement. Another example is that most surgeons reach the sphenoid sinuses by going through the anterior and posterior ethmoid sinuses. This changes the CPT code assignment, and the revenue.

ASC coders also may overlook additional ENT procedures, Schade-Boyce says. If surgeons obtain material from the septum or ear for grafting procedures, CPT guidelines allow coders to report and bill for grafts when the surgeon corrects septal or nasal vestibule complexities.

Editor's note: This topic is from the April 2008 issue of Ambulatory Surgery Coding & Reimbursement Insider.

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