Common ASC coding errors: Podiatry, otolaryngology & more

Caryl Serbin, RN, BSN, LHRM, President and Founder, Serbin Medical Billing - Print  |

As discussed in Part I of this article, coding for procedures in all specialties is often a complex process. In Part I we discussed common areas that are prone to erroneous coding in orthopedics, gastroenterology and ophthalmology. Part II of this two-part series focuses on podiatry and otolaryngology and provides universal coding tips applicable to most specialties.

Podiatry
There were major changes to podiatry codes in 2017. AMA added two new codes, deleted three bunionectomy codes and revised multiple codes. The following is a brief summary of the affected codes:

New

Deleted
The following bunionectomy codes have been deleted in order to eliminate all proper names from code descriptions (Austin, McBride, etc.) and more accurately describe the services as they are currently performed:

Revised

Multiple procedure codes may be listed for one operative note but some of them may be considered part of the more complex procedures being performed. Separate procedure codes may sometimes be billed with other codes, but be aware of what the payer’s requirements are for these codes. Careful review of all the codes in this range is recommended before choosing the final code for bunion correction.

Otolaryngology (ENT)
ENT can often be difficult to code as it encompasses four parts of the respiratory system: 1) ears; 2) nose; 4) sinuses and 4) throat. In addition, there are eight sinuses, six turbinates and two separate nasal cavities to choose from and an extensive range of procedure codes spanning several different areas of CPT codes.

The following are a few areas where errors can occur:

General coding tips
The following are suggestions that may be helpful in achieving accurate coding of procedures in all specialties:

Modifier tips
Most modifiers used in ASC coding are two-digit numbers. Modifiers provide additional information to payers to make sure the provider is paid correctly for services rendered. If appropriate, more than one modifier may be used with a single procedure code; however, they are not applicable for every category of the CPT codes. Some modifiers can only be used with a particular category and some are not compatible with others.

Here are some tips to aid with appropriate modifier use:

Modifiers -73 and -74 – It is critical that you understand the difference.

Other modifiers that may be appropriate in the ASC setting include the following:


Be vigilant
Although there are many other surgical specialties that utilize the ASC arena, this two-part series showcased just a few of the more common coding errors and provided tips to help coders avoid the many pitfalls they may encounter. One of the most important components of correct coding is accurate and detailed procedure notes. Remember the adage: If it’s not documented, it didn’t happen.

Caryl Serbin, RN, BSN, LHRM , is president and founder of Serbin Medical Billing, an ASC revenue cycle management company. Serbin Medical Billing's primary objectives are to provide the best coding, billing and accounts receivable management services available to ambulatory surgery centers (hospital joint-venture, corporate-owned or independent) and anesthesia providers. Serbin has been a leader in the ASC industry for 30 years. She was the founder of the first ASC-specific billing company.

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