![]() In this scenario, the ORL assists the NS by holding the endoscope and vice versa. Consider an endoscopic transnasal approach to the anterior cranial fossa, intradural resection of a clival chordoma, with dura repair and septal flap closure. Also, CPT guidelines state it is not appropriate to append a modifier to an unlisted code because an unlisted code does not describe a specific procedure.īecause each surgeon is performing his or her own separate procedure in endoscopic/endonasal skull base surgery, much like in the use of the existing skull base surgery codes, we recommend each surgeon report his or her own unlisted CPT code (ORL–31299, NS–64999). It is not accurate to report individual component codes (e.g., endoscopic sinus surgery, septoplasty) instead of an unlisted code for endoscopic skull base surgery as this is not in line with CPT coding guidelines.Įach unlisted CPT code is used to describe the actual work by each surgeon. We have found that many payers fail to recognize, and appropriately reimburse, claims where both surgeons report the same unlisted code with modifier 62 (e.g., 64999-62). Many otolaryngology and neurosurgery practices have implemented a successful coding and reimbursement strategy for performing endoscopic skull base surgery procedures together. Both the AAO-HNS and the American Association of Neurological Surgeons agree it is not accurate to use the existing skull base surgery CPT codes for endonasal/endoscopic procedures because the existing codes describe an open procedure involving skin incision(s). Therefore, endonasal/endoscopic skull base procedures, except the endoscopic resection of a pituitary tumor (62165), do not have a CPT code. Endonasal/endoscopic skull base surgery is relatively new and performed in a limited number of organizations. The existing open (involving a skin incision) skull base surgery CPT codes were introduced to the CPT code system in 1994. Modifier 62 (two surgeons) is appended to 62165 when performed as co-surgery involving the otolaryngologist (ORL) and neurosurgeon (NS) to show that neither surgeon performed the entire procedure code. Only one CPT code exists for an endoscopic skull base procedure-62165, Neuroendoscopy, intracranial with excision of a pituitary tumor, transnasal, or trans-sphenoidal approach. Unlike the skull base surgery codes that include separate codes for the approach and definitive procedure, CPT 62165 includes the approach, tumor resection, and closure. The contemporary practice of medicine is occasionally ahead of the CPT code system and an accurate code may not always exist for the procedure performed this is true for reporting most endoscopic/endonasal skull base surgery procedures.Coding Issues The American Medical Association’s Current Procedural Terminology® (CPT) codes for reporting medical services and procedures performed by physicians must be used to bill services to third party payers. To read the full article, sign in and subscribe to the AHA Coding Clinic ® for HCPCS.Coding and Reimbursement Strategies: Using an Unlisted Code for Endoscopic Skull Base Surgery Our facility wants to know which CPT code should be assigned for transmastoid repair of encephalocele with mastoid obliteration and bone grafts? Would CPT code 69670 be the appropriate code for the entire procedure or should it be coded to 62121? To ensure the tegmen mastoideum defect was repaired and the CSF leak was sealed, fascia and bone chips were utilized to fill the defect.Īlso, multilayered closure was performed with gelfoam, fascia, bone pate with fibrin glue placed in sheets to obliterate the mastoid cavity. However, there was a large tegmen mastoideum defect. Next, an 8mm encephalocele was treated via cauterization and was reduced. Utilizing the operating microscope a mastoidectomy was performed with removal of bone from the mastoid cortex. An additional incision was made exposing the mastoid and bone shavings were also taken for later use. A postauricular incision was made, the ear was undermined and a portion of the fascia was removed for use later. Patient with an encephalocele and a cerebrospinal fluid (CSF) leak which caused inflammation of the mastoid mucosa presents for transmastoid repair of the encephalocele with mastoid obliteration. News - industry news & Find-A-Code updatesĪHA Coding Clinic ® for HCPCS - 2020 Issue 1 Ask the Editor Repair of encephalocele with mastoid obliteration.Marketplace - recommended products & services.Library - buy digital books from Find-A-Code. ![]() ![]() Bookstore - buy physical books & cheat sheets.Subjects - Audits, E&M, HIPAA, Practice Mgt, etc.Specialties - Cardiology, ENT, Family Practice, etc.Payers - Medicare, Medicaid, BC/BS, Aetna, etc.Facilities & Organizations - ACOs, Hospitals, etc.
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