Coding Corner

As a new benefit for Members, the Academy is proud to release our AAO-HNS Coding Corner.

The coding corner makes accessing the newest coding and reimbursement tools simple and straightforward for Members.

Additional Information

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Coding Education / Courses
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Coding and Reimbursement Workshops

Enhance the business side of your clinical practice by attending the regional workshops conducted by Karen Zupko & Associates. The course sessions, two options on Friday and one on Saturday, are designed to help you with your business and administration skills, ICD-10, and ensure you are coding correctly.

Learn More.

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Coding Guidance: CPT for ENT Articles
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CPT for ENT Articles

CPT for ENT articles are a collaborative effort between the Academy’s team of CPT Advisors, members of the Physician Payment Policy (3P) workgroup, and health policy staff.  Articles are developed to address common coding questions received by the health policy team, as well as to clarify coding changes and correct coding principles for frequently reported ENT procedures. 

Code Changes for CY 2014

Audiology Billing Information

Information on NCCI/ MUE Edits

The CMS National Correct Coding Initiative (NCCI) promotes national correct coding methodologies and reduces improper coding which may result in inappropriate payments of Medicare Part B claims and     Medicaid claims.  The National Correct Coding Initiative (NCCI) contains two types of edits:
1. NCCI procedure-to-procedure (PTP) edits that define pairs of Healthcare Common Procedure Coding System (HCPCS) / Current Procedural Terminology (CPT) codes that should not be reported together for a variety of reasons.  The purpose of the PTP edits is to prevent improper payments when incorrect code combinations are reported.
2. Medically Unlikely Edits (MUEs) define for each HCPCS / CPT code the maximum units of service (UOS) that a provider would report under most circumstances for a single beneficiary on a single date of service.

E/M Documentation Guidelines

The Medicare Learning Network® (MLN) Educational Web Guides Documentation Guidelines for Evaluation and Management (E/M) Services offers health care professionals E/M services information and resources. These guides are designed to provide education on evaluation and management services. It includes the following information: medical record documentation, evaluation and management billing and coding considerations. E/M services health care professionals may use either version of the 1995 or 1997 documentation guidelines, not a combination of the two, for a patient encounter. 

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Payer Denials and Appeals
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Template Appeal Letters
In order to assist with your reimbursement needs the Academy of Otolaryngology—Head and Neck Surgery has created template letters to assist you with denials on specific procedures. These letters are generic and act only as guidance for you to construct your appeal letters. They do not purport to address the details of your appeal. You should use your company letterhead/logo as well as fill in the blanks and header information. We recommend that you also submit any other relevant supporting documents (for example medical notes, operative reports etc.)

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Background: CPT Editorial Panel, AMA RUC, & Academy New Technology Pathway Process
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Overview of CPT Editorial Review Process
The attached slide set was prepared by long time CPT Advisor, Past 3P Co-Chair, and Academy President; Richard W. Waguespack, MD, to provide a brief and easy to understand guide for members on the CPT Editorial Panel’s process for reviewing code change proposals (CCPs).  These slides cover the method by which a new code is created, or an existing code is revised, as well as literature and other requirements set forth by the AMA in order to obtain approval for a CCP. 

How to Apply for, or revise, a CPT Code - New Technology Pathway

*NEW* AAO-HNS New Technology Pathway Requests Policies and Procedures (May 2014)
There are specific procedures in place both at the Academy and within the AMA to evaluate recommendations to changes in the Current Procedural Terminology (CPT) code set. The Academy has a dedicated CPT & Relative Value Committee to address these issues. This committee is comprised of experienced physician who have served as Academy representatives to the CPT Editorial Panel and the RVS Updating Committee (RUC) through the Physician Payment Policy Workgroup (aka “3P”). The committee also includes a dedicated staff member to interact with interested stakeholders in the CPT code development and revision process. Stakeholders interested in working with the Academy to obtain a new CPT code, or revise an existing CPT code set, should begin by obtaining a copy of the Academy's New Technology Pathway requirements. For more information on the New Technology Pathway process, click the heading above. For the AAO-HNS statement on new technology and information about communication procedures and lobbying policies, please see the AAO-HNS New Technology Pathway Requests Policies and Procedures document above.

Obtaining RVUs for CPT codes
Immediately following the CPT Editorial Panel’s acceptance of the new code change proposal (CCP), the RUC process begins.  All participating specialties have an opportunity to indicate a “level of interest” from which indicates their interest in developing relative value recommendations for the new code(s). All societies have 4 options:

  1. Survey their members to obtain data on the amount of work involved in the services and develop recommendations;
  2. Comment in writing on recommendations developed by other societies;
  3. In the case of editorially changed/ revised codes, they could decide that the coding change does not require action because it does not significantly alter the nature of the service or the previously assigned relative value; or
  4. Take no action because the codes are not used by physicians in their specialty.

The Academy Needs You! Fill Out a RUC Survey
The Academy needs experts three times a year to fill out RUC surveys for the AMA Specialty Society/ Relative Value Update Committee! The RUC is a joint effort of the American Medical Association and medical specialty societies that makes recommendations on revising and updating the resource-based relative value scale (RBRVS), which is utilized by Medicare and many private payers to determine reimbursement for medical services. Information, such as the time and intensity takes to perform certain services for patients are derived by surveying physicians who have expertise in performing those services. This information is critical to ensuring appropriate valuation.

The Academy strongly encourages members who are familiar with a procedure undergoing a RUC survey to take the time to complete a survey. Filling out a survey takes about 20 minutes. Before completing a survey, please review important background information by viewing the following slide set developed by the AMA RUC, which can be found here. Background on the RUC survey process and instrument can be found in this 2011 May Bulletin article (login required).

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CMS Quality Initiatives and Programs
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Detailed information on the Electronic Health Record (EHR), Physician Quality Reporting System (PQRS), Electronic Prescribing (eRx), and Value Based Payment Modifier (VBPM) programs and how you can earn incentives and avoid penalties. 

Click to view the Academy's Quality Initiatives page.

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ICD-10 Coding Resources