Health Information Management

Tip of the Week: Steer clear of sinus surgery coding slipups

APCs Insider, August 24, 2007

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Otolaryngologists, commonly known as ear, nose, and throat physicians (ENT), must complete a rigorous amount of training to perform their surgical techniques.

Coders, in turn, need an amassed set of knowledge in order to code intricate sinus surgeries.

Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, director of outreach programs for the American Academy of Professional Coders (AAPC) in Tinton Falls, NJ, says there are two modifier misuses that you should watch for in particular:

1. Modifier -59 (Distinct procedural service): This modifier has been the subject of ongoing debate and continues to remain on the Office of Inspector General (OIG) Work Plan.

Coders often use it to unbundle procedures inappropriately. "It's like the universal unbundler, and it's very targeted by payers, the OIG, and CMS," Cobuzzi says. She suggests that coders use modifier -59 when:

  • A physician performs two procedures that are normally bundled on two separate operative sites
  • A physician performs two procedures that are normally bundled in different operative sessions

For example, Cobuzzi notes that coders often get frustrated when they try to append modifier -59 to bundled codes 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral), and 30903 (Control of nasal hemorrhage, anterior complex).

2. Modifier -50 (bilateral procedure): This modifier applies only to procedures that are performed on two sides of the body. Cobuzzi warns that if a procedure code's descriptor includes "unilateral or bilateral," you cannot use it to bill a bilateral procedure, because the base code includes both unilateral and bilateral performance.

For example, you cannot append modifier -50 to code 31231.

(The above tip appeared in the September 2007 issue of Briefings on APCs).

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