Common Otolaryngology (ENT) Coding Mistakes

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Common Otolaryngology (ENT) Coding Mistakes
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 (ENT) 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
coders 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.
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Common Otolaryngology (ENT) Coding Mistakes
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.
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Common Otolaryngology (ENT) Coding Mistakes
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.
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Common Otolaryngology (ENT) Coding Mistakes

• 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 surgeons 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.

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Common Otolaryngology (ENT) Coding Mistakes
We conduct regular training to keep our coding
team updated 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!