Coding Corner

AMA CPT Code Set Revision and RUC Processes

The following process is required for a new technology or revised procedure to receive a Current Procedural Terminology (CPT) Code, receive a value, and establish a Medicare payment:

1. The process begins with review of a Code Change Application (CCA) application by the AMA CPT Editorial Panel.
2. After approval by the CPT Editorial Panel, the AAO-HNS is involved in surveying members and making recommendations for a relative value unit (RVU) at a presentation before the AMA/Specialty Society Relative Value Update Committee (RUC).
3. CMS reviews the RUC recommendations and makes a final decision about the RVU, and a dollar amount is calculated.

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AAO-HNS New Technology Pathway Process

As a part of supporting new technology, the Academy welcomes opportunities to address coding and reimbursement issues for Otolaryngology-related new or revised CPT or HCPCS codes. The New Technology Pathway was developed to provide a framework for transparent, ethical engagement between the Academy and industry representatives in a manner that encourages responsible decision making.

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• CPT® Editorial Summary of Panel Actions September-October 2021
• CMS E/M Services Guide
• Top 100 ENT Billed Services for CY 2023 (hospital outpatient and physician office settings) Facility | Non-Facility
• Top 100 ENT Billed Services for CY 2022 (hospital outpatient and physician office settings) Facility | Non-Facility
• Top 100 ENT Billed Services for CY 2021 (hospital outpatient and physician office settings)  Facility | Non-Facility
• Top 100 ENT Billed Services for CY 2020 (hospital outpatient and physician office settings) Facility | Non-Facility
• Top 100 ENT Billed Services for CY 2019 (hospital outpatient and physician office settings) Facility | Non-Facility
• Top 100 ENT Billed Services for CY 2018 (hospital outpatient and physician office settings) Facility | Non-Facility
• Joint Coding Guidance (AAO-HNS/AOS/ANS): Bone Anchored Hearing Aids (69714/69715)
• AMA CPT Assistant: Removal of Impacted Cerumen (69209)
• AMA CPT Assistant: Updated Endoscopic Nasal/Sinus Surgery Codes for 2018

Audiology Billing Information

• Clarifying Medicare Audiology Billing Services: Audiology and Oto-tech FAQs

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.

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.